Health Portfolio Committee Report on oversight visits to Free State and Eastern Cape

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Health

08 March 2011
Chairperson: Dr B M Goqwana (ANC)
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Meeting Summary

The Chairperson reported on the 29 baby deaths at the Cecilia Makiwane Hospital in East London in the Eastern Cape in the month of January. It was felt that a committee delegation ought to visit that hospital.

The Committee report on its oversight visit to Free State was adopted with these changes:
Additional findings were:
- Both Pelonomi and Universitas were referral hospitals, the services should be rationalised.
- Lack of infection control.
- Lack of asset management and inventory of equipment
- Malfunctioning management at Bongani Hospital.

Recommendations added were:
- Province must implement infection control as a matter of urgency, together with a monitoring mechanism;
- Timeous ordering of medicine and payment;
- Community service doctors needed supervision;
- The primary health care system must be beefed up;
- Hospitals must communicate for benchmarking purposes;
- Vacant posts must be filled, there must be a guiding policy;
- The establishment of clear communication mechanisms throughout the health sector;
- Provinces must locate ambulances;
- The maternity ward at Pelonomi should be better staffed and equipped;
- That the management at Bongani go for training.

The Committee report on its oversight visit to Eastern Cape was adopted with these changes:
Additional findings were: Findings added: The bad attitude towards the Committee, let alone towards the patients they were handling; quality and quantity of capacity; no monitoring by authorities of the province and the staff, performance monitoring was needed; and lack of appropriate training of hospital personnel.

The Committee made the following recommendations:
- Implementation of the infection control policy and the Province must ensure the implementation of that policy through inspections;
- The handbook for employment of senior staff members be adhered to and that due process be followed;
- An asset register to account for equipment;
- All vacancies must be filled as a matter of urgency;
- Delegation of powers to hospital managers to enable them to deal with issues of repairs and maintenance;
- Implementation of ICT so that filing and record keeping can be improved;
- There must be performance monitoring and ongoing in-service training;
- Performance monitoring should be linked to the payment of bonuses;
- The role of the province in ensuring things happened, and in providing support.
- Primary health care must be revised so hospital receive only those people who were referred by the clinics.

Meeting report

The Chairperson announced that some Members would be attending a workshop in Durban on domestic violence on 24 and 25 March, but because Parliament was sitting on 24 March those Members would only be allowed to attend for the day of 25 March.

Mr M Waters (DA) asked why the Committee had received the Committee Reports on the oversight visits so late. The Free State report was six months old and the Eastern Cape report was eighteen months old; it was very difficult to cast one’s mind back to the memory of the visits.

The Chairperson explained that with the Eastern Cape report, the MEC had asked to see the report first and the Chairperson had agreed to that. The MEC did not come back to the Committee and was transferred to another department and his comments were not received.

On the Free State report, the Committee Secretary said the report had been ready but it was a matter of not having sufficient time in the meetings for Members to adopt it.

Mr Waters asked whether the MEC wanted to see the report before it was adopted?

The Chairperson replied that they had a meeting to discuss issues raised by the Committee, and the MEC wished to discuss that.

Mr D Kganare (COPE) said that was a mistake, because the report should have been what the Committee had observed, not about what the MEC wanted. The Committee could call them thereafter to report on the recommendations made.

The Chairperson agreed, it would never happen again.

Oversight visit to the Free State

[
There was some confusion as there were two versions of the report, an earlier one and an edited one.]

Mr Kganare felt it should be captured somewhere in the Executive Summary that the Committee had tried to meet with the MEC but he had avoided the meeting.

The Chairperson agreed that the attitude of the people should be mentioned. It was obvious that some of the people at Bongani Hospital did not understand what the Portfolio Committee was supposed to be doing. That could be put under findings.

The Chairperson expressed the opinion that the leadership of Manapo Hospital seemed to have a very good attitude and capacity. It seemed they were doing well and up to scratch with the challenges they had.

Ms B Ngcobo (ANC) expressed concern that under Point 7.5.7, the hospitals could refer patients to themselves. If a case was critical, Pelonomi Hospital was 350 kilometres away and the roads were bad. She suggested rather recommending that one of the hospitals in that area be upgraded.

The Chairperson felt that self-referral was a mistake that needed to be corrected. The people there were self-referred. In the referral system, the first point of entry was that there must be a doctor, in which case the patient would not be critical anymore. When a patient was referred by Manapo Hospital, it was only that the patient had reached the next level.

Ms Bongani said if a case was critical it meant that the staff had determined that the doctor at that particular hospital had determined that.

The Chairperson said it was a matter of enough doctors to handle the patients that came to them. The referral system needed to be upgraded so that when people arrived at a clinic, there must be a doctor to handle the patient and, if necessary, take the patient to the next level. He clarified that those patients that the staff were not able to handle at Manapo, were referred to the next level.

Ms Ngcobo added that there should be a policy of agreement that from that area in the Free State, the hospitals could transfer to the East Rand.

The Chairperson responded that National Government did have a policy. Aliwal North was 200 kms from Bloemfontein, which was a referral hospital for the Free State, and the referral hospital for the Eastern Cape from Aliwal North was 400 kms, and that could only be done if the patient could be attended at Pelonomi or Aliwal North. The tertiary institutions needed to belong to National, so that anybody could refer without having problems.

Mr Waters pointed out that the two versions of the report differed in their stated Objectives. The original version said the purpose of the visit was to conduct an oversight function in assessing the quality of health service delivery in terms of HIV/AIDS and infection control. Infection control was not mentioned in the edited version. Infection control was very important, particularly with all the baby deaths. The document mentioned infection control, which was not mentioned in the edited version.

[After some discussion, it was decided to deliberate on the original report.]

It was agreed that there should be a separate item for the pharmacy and the medical depot. Hospitals complained that they were not getting the medicines on time; and the depots were not ordering in time. The medical depots complained about payment, institutions were ordering but not paying.

Additional findings were:
- Both Pelonomi and Universitas were referral hospitals, the services should be rationalised.
- Lack of infection control.
- Lack of asset management and inventory of equipment
- Malfunctioning management at Bongani

The recommendations that were added were:
- Province must implement infection control as a matter of urgency, together with a monitoring mechanism;
- Timeous ordering of medicine and payment;
- Community service doctors needed supervision;
- The primary health care system must be beefed up;
- Hospitals must communicate for benchmarking purposes;
- Vacant posts must be filled, there must be a guiding policy;
- The establishment of clear communication mechanisms throughout the health sector;
- Provinces must locate ambulances;
- The maternity ward at Pelonomi should be better staffed and equipped;
- That the management at Bongani go for training.

The report was adopted with changes.
 
Oversight visit to the Eastern Cape
Mr Waters said there was a need to mention somewhere in the report that the CEO of the Nelson Mandela Hospital was still acting; two or three years prior to that the same CEO was Acting and living in a hotel.

Mr Kganare asked for clarification of the roles of Superintendent, Acting Hospital CEO, Cluster Hospital CEO, and Cluster CEO, on page 7.

The Chairperson clarified that the Superintendent managed the clinical services, and the doctors fell under him. The CEO was the executive of the whole institution – doctors, nurses, administration, and human resources. The Cluster Hospital CEO for that particular area was the CEO for the whole region - referral hospitals, district hospitals, and the clinics in the area. The Cluster CEO took care of the services around the institution. Nelson Mandela was an Academic Complex under one CEO.

It was noted that Mr Waters’s concern about the Acting CEO was mentioned under Point 4.3, and that she had told the Committee not to ask that question. People outside Parliament were not aware of the role of the Committee.

Mr Waters referred to 5.1. The CEO was still there, and received a performance bonus, and the babies were still dying.

The Chairperson responded that the matron was supposed to have been removed.

The Chairperson referred to page 18. A concern needed to be added that some of the people, especially the Cluster CEO, when the delegation met at Nelson Mandela, were complaining that the eastern side of the Eastern Cape was not well looked after by Bisho and they were not getting enough human resources for the north-eastern side.

Items added to the findings were:
- the bad attitude towards the Committee, let alone towards the patients they were handling;
- quality and quantity of capacity;
- no monitoring by authorities of the province and the staff, performance monitoring was needed;
- lack of appropriate training of hospital personnel.

The Committee made the following recommendations:
- Implementation of the infection control policy and the Province must ensure the implementation of that policy through inspections;
- The handbook for employment of senior staff members be adhered to and that due process be followed;
- An asset register to account for equipment;
- All vacancies must be filled as a matter of urgency;
- Delegation of powers to hospital managers to enable them to deal with issues of repairs and maintenance;
- Implementation of ICT so that filing and record keeping can be improved;
- There must be performance monitoring and ongoing in-service training;
- Performance monitoring should be linked to the payment of bonuses;
- The role of the province in ensuring things happened, and in providing support.
- Primary health care must be revised so hospital receive only those people who were referred by the clinics.

The report was adopted with these changes.

The Chairperson apologised that the reports had come late, it would not happen again.

Minutes of Committee meetings
The minutes of the Committee meetings of 25 January, 8 and 23 February 2011 were adopted with changes.

Mr Waters asked the Chairperson to brief the Committee on the proposed visit to East London regarding the deaths of babies.

Proposed visit to East London
Regarding the baby deaths in the Eastern Cape, in 2006 there were baby deaths at Frere Hospital in the Eastern Cape and the National Department of Health had sent a delegation that came up with recommendations. Subsequent to that there were baby deaths in Mthatha. A task team was set up to explain what had happened. Now 29 babies had died in the month of January, and since then another 15 had died. This time it was not Frere Hospital, but it was the same hospital as a spate of deaths three years ago. It was felt that a delegation ought to visit this hospital, specifically touching on what happened before, because it was the same leadership and included Frere, so was happening under the same matron.

The meeting was adjourned.



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