Child Mortality & Infection Control in Eastern Cape: Provincial Department of Health appearance

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Health

10 August 2010
Chairperson: Mr B Goqwana(ANC)
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Meeting Summary

The Committee was to be briefed by the Eastern Cape Health Department on the high incidence of neo-natal deaths which had occurred this year at Nelson Mandela Academic Hospital in Mthatha. It had called for a full explanation on the issue from the relevant parties, in view of the serious concerns about recurrent instances of patient deaths in that province, and in particular that the continuing baby deaths might prevent the millennium development goals from being met. Members noted at the outset that although a full delegation had been expected, including the MEC for Health and the hospital management and staff, only the Head of the Eastern Cape Provincial Department of Health was in attendance. He explained that the MEC and other officials needed to remain in the Eastern Cape to handle the visit by the State President, and that the Department was also attempting to reduce travelling expenses by sending smaller delegations, as part of its financial austerity measures. He maintained that he personally was dealing with the incidents of baby deaths, and wanted to assure Members that measures were being taken to address the problem, including monthly monitoring. He said that he could give an honest report on what had happened and what the Department was doing to move forward.

The Chairperson thought that people might be reluctant to report fully to senior management of the Department but would be more open with the Committee, and that it was desirable also to hear from a wide range of people. Members agreed with these sentiments, pointing out that although Dr Pillay was the administrative head, he bore no operational responsibility. Several Members noted problems highlighted during the Committee’s oversight visit to Eastern Cape, and said that these issues should also be addressed, with report-backs on what had been done to improve the situation since that visit. Members noted that the Province must find the financial resources to bring people before the Committee, and agreed that this meeting should not proceed, but that a new date must be set so that the hospital personnel, the MEC’s office and the Provincial Department could account to the Committee, and in particular so that the MEC could furnish or explain the reasons why the report promised six months ago had not been provided to the Committee. The allegations by people in Mthatha that the Bisho head office was preventing them from performing their work properly must also be discussed. It was possible to arrange the times so that the delegation did not have to stay in Cape Town overnight. After initially questioning the decision, Dr Pillay stated that he accepted the ruling and would await a new date.


Meeting report

Child Mortality & Infection Control: Eastern Cape Provincial Department of Health briefing
Chairperson’s opening remarks
The Chairperson stated that the Committee had called the Eastern Cape Provincial Health Department (the Department) to report to it on the high incidence of neo-natal deaths which had occurred this year at Nelson Mandela Academic Hospital in Mthatha. This Committee was seriously concerned about the matter, wanted to know what had led to the deaths and what strategies were being adopted by the Department to diagnose and contain the problems and prevent their recurrence. The Committee was also concerned about meeting the millennium development goals (MDG) on maternal health and infant mortality.

The Chairperson noted an apology on behalf of Mr M Waters (DA), tabled by his colleague Ms E More (DA), and proposed that a letter be sent to Mr Waters conveying the Committee’s good wishes for the recovery of his family member.

The Chairperson then welcomed Dr Siva Pillay, Superintendent General, Eastern Cape Provincial Health Department, and enquired whether he was the only representative from the Eastern Cape present.

Dr Pillay stated that he was appearing alone, because the visit of the State President to the Eastern Cape meant that the MEC for Health and other Provincial Health Department personnel were attending to the State President. He added that this Department was also under severe financial constraints, and that it had adopted various austerity measures, including cutting down on travel costs.

The Chairperson reiterated that the Committee had extended the invitation to the Eastern Cape Provincial Department as a result of seriously concerns about the baby deaths in that province, especially in Mthatha, and the general situation at the Nelson Mandela Academic Hospital. Members wanted to know, from the people on the ground, what had happened, and what challenges were faced, in order that the problem could be addressed, contained and prevented from happening elsewhere in the Eastern Cape, and indeed in other provinces.

The Chairperson asked Members whether they believed it was worthwhile for the meeting to continue in the absence of a representative delegation.

Dr Pillay informed the meeting that he personally was dealing with the incidents of baby deaths, and wanted to assure Members that measures were being taken to address the problem. The Department had embarked upon a co-ordinated campaign, called 'Saving mothers, saving babies'. An independent body of experts had been appointed to monitor the situation, on a month-to-month basis, for a period of three months.

Dr Pillay conceded that it did happen that attempts would be made to cover-up matters and it was difficult to get the correct information from the responsible staff. However his presentation would give an honest reflection of what had happened and would encompass what was being done by the Department to move forward. He asked that he be given the opportunity to present his findings to the Committee.

The Chairperson intimated that people might be reluctant to be fully open on the challenges they were experiencing, given Dr Pillay's senior management position in the Department. Although the Committee had wanted to hear from a wider range of people, he suggested that the Members should decide how they wished to proceed.

Discussion
Ms L Makhubele-Mashele (ANC) stated that the Committee had invited the hospital in Mthatha to attend, and she had expected the Chief Executive Officer (CEO) and senior management to be present. She acknowledged Dr Pillay's comments around financial constraints preventing a large delegation from meeting with the Committee, but felt that it would not be fair for the Committee to hear his comment on what had been put in place, since the Committee wanted specifically to listen to the people who had been assigned the responsibility for taking care of patients in the hospital, and to hear exactly what had caused the deaths. The Head of a Department was administratively the senior officer, but was not responsible operationally for the hospital where the incidents occurred. She proposed that another invitation be sent to the senior management of the hospital, calling upon them to meet with the Committee to account for their actions. If there were financial constraints, then a letter should be sent to the National Department of Health (NDOH) asking that this Department provide financial assistance for travelling expenses.

Ms T Kenye (ANC) concurred with Ms Makhubele-Mashele. She pointed out that quality of health had to include both babies and unborn children. A full report was needed, so both the hospital management and the Department should meet with the Committee.

Ms M Mafolo (ANC) concurred with both previous speakers. She added that the Committee’s oversight visit to the Eastern Cape had revealed serious problems in healthcare in that province, and she wanted to hear directly from the people involved.

The Chairperson said that Dr Pillay was new in his post. There had been baby deaths in the Eastern Cape before, at Frere Hospital, and in Ukhahlamba district, with this being the third instance. The Committee wanted the Department to take these very seriously and establish what was going wrong, and if there was something that could be done to assist the hospitals. The MEC should have been present, but his inability to attend because of the State President’s visit was understandable. However, there was no excuse for the others not being present.

Dr Pillay felt that the Members were pre-empting his presentation, but accepted their comment. He said that there was an investigation into the baby deaths at Nelson Mandela Academic Hospital and the Chief Executive Officer (CEO) of that hospital was part of that process.

Dr Pillay attempted to table and explain a slide showing a map of the Eastern Cape, but the Chairperson asked him to stop, inferring that he would be out of order to proceed with the presentation.

The Chairperson asked Dr Pillay to comment on those personnel from Mthatha and the Nelson Mandela Academic Hospital who should have been present.

Dr Pillay said that he would welcome financial assistance, and if this were to be provided, then there would be no problem about having these representatives appear before the Committee.

Ms Makhubele-Mashele said that Dr Pillay's statement that he would welcome financial assistance seemed to imply that the Committee should find the finances to bring the relevant people to Parliament. She stressed that it was the responsibility of the Committee to summon people to Parliament to account for how they had or had not discharged their duties. She considered that Dr Pillay, as the senior administrative officer and HOD of Health in the Eastern Cape Province, should have found the means to bring the hospital management team to Parliament.

Ms G Saal (ANC) felt that Dr Pillay's responses highlighted why the Committee should not allow him to present alone. She had the sense that he may not have wanted the relevant people to be present. The Department had been allocated funds, and therefore should have managed its funding to ensure that the relevant people could attend. She commented that during the Committee’s recent oversight visit, Members had found that management had a way of suppressing information. She appealed to Dr Pillay to bring the relevant people to meet with the Committee.

Ms Mafolo agreed with Ms Makhubele-Mashile. This was an urgent matter, and she believed that another date should be set by the Committee so that the relevant people could come and account for what had happened, in order to prevent a recurrence of the problems.

Ms Kenye added that the Committee’s oversight visit to the Eastern Cape had revealed many problems in healthcare. The MEC of Health had pleaded that six months be allowed to compile a report, but although that six months had now elapsed, the report was still awaited.

The Chairperson stated that the HOD should look into that issue.

Ms More agreed with the previous comments, and agreed that when the Committee met with the MEC, many problems in healthcare became apparent, and that many promises had been made to rectify them. She felt it unfair that the new HOD was being asked to represent the whole province alone. The Nelson Mandela Academic Hospital management, in particular, should have been present, including Unit Manager level, and it was indeed necessary, as previously stated, for those “on the ground” to account for what had happened. Management often suppressed information from those on the ground, and this must be prevented. It had to be understood that the process would serve to better the healthcare of the citizens of the country; it was not to be seen as the opportunity to discipline people. However there were many questions to be asked of the MEC and those affected. They could also apprise the Committee of what had been done since the Committee’s oversight visit, whether promises had been kept, and, if so, why these deaths had nonetheless occurred. She agreed that the Committee had a duty to summon the relevant people from the Eastern Cape Health Department. She agreed that a new date be set to continue the meeting with all present.

Mr D Kganare (COPE) hoped that no cover up was taking place. There were some larger issues also, as alluded to by the previous speakers, including the situation in Mount Frere and the commitments made by the MEC. He suggested that the proposed meeting begin at 10:00, so that the Eastern Cape delegation could travel to and return from Cape Town on the same day, thus cutting out accommodation costs. He noted that the questions to be posed would have to be very specific. If Dr Pillay had made his presentation, the questions would surely have gone beyond the stated agenda. He appreciated Dr Pillay's commitment in taking responsibility for what had happened in his area, but agreed that he must bring a full team to account for what had happened, and accept that since this was not a regular occurrence, it should not affect his budget too badly.

Ms More pointed out that the Eastern Cape was not that far from Parliament and agreed that it was possible to make a day trip.

Mr E Sulliman (ANC) thought that there was no point in continuing this meeting, since the HOD could not take political responsibility. He therefore proposed that the meeting be brought to a halt.

Ms Saal seconded that proposal.

The Chairperson noted that baby deaths had been the only item on the agenda, but the matter would not be discussed further.

The Chairperson thanked Dr Pillay for his attendance. He reiterated that the Committee must fulfil its oversight role. Members were concerned about the baby deaths and whether the Millennium Development Goals would be attainable. Strategies could be adopted nationally, but they must be supported on the ground. Baby deaths had far-reaching implications and involved all levels of health, from primary to tertiary. The Committee did not wish to be unduly harsh, but had a duty to ask what was causing these recurrent baby deaths in the Eastern Cape.

The Chairperson said that when Parliament called people from the community to give input, they were catered for. Although it was accepted that health was under-funded, this was not up for discussion today. The Province, when called to Parliament, must fund its attendance. A new date would be set, and the HOD must be accompanied on that occasion by all the relevant people.

The Chairperson said that during the oversight visit, the Committee had been informed by people in Mthatha that the problem lay with the head office in Bisho, which was obstructing people from doing their work. Those making the allegations would be invited to meet with the HOD and the MEC to expose the problems. Other issues were also raised, including that certain areas of Transkei were not supported to do their work. This was why it was necessary to talk openly and hear directly from people on the ground. It was not possible to set a date for the new meeting immediately, but Dr Pillay would be advised of it.

Dr Pillay said that he felt it was unfair not to allow him to proceed. He had told Committee Members of the difficulties, and he was not responsible for the inability of others to attend.

Ms Saal noted, as a point of order, that a meeting that had been adjourned could not be allowed to re-start. Members understood what had been said and had agreed on the process to be followed. Dr Pillay’s explanations were now simply wasting time.

Dr Pillay stated that he accepted the ruling and would await a new date.

The meeting was adjourned.


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