Domestic Violence Act implementation report by Deputy Minister & Department of Health

Women in The Presidency

06 March 2012
Chairperson: Ms B Mabe (ANC)
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Meeting Summary

The Department of Health (DOH), in the presence of the Deputy Minister of Health, briefed the Committees, sitting jointly, on their progress on implementation of the health-related provisions of the Domestic Violence Act (DVA). However, the data presented dated back to 1997 and 2007, a point of major concern. The DOH noted that this response formed part of the response on the quadruple burden of disease facing South Africa, as that encompassed HIV and Aids, maternal and child mortality, non-communicable disease, and violence and injuries. The DOH stressed that the figures presented probably were greatly understated, and that government and society needed to address the much larger problem in a composite way. Victims’ and survivors’ needs in post-rape and sexual assault care were paramount. Psychosocial support was another issue that the committees had raised in the past, and the DOH had developed Human Resource plans to try to identify and fill skills gaps. Shortages of health professionals were noted, but it was noted that although psychologists and occupational therapists were not listed, the DOH was recruiting people to place them in community services, and was offering bursaries. The DOH was only involved with domestic violence directly if the Court asked for mental observation of perpetrators. However, it needed to collaborate with other departments, such as South African Police Services, to ensure that databases were up to date, and the DOH also collaborated on the Victims Empowerment Management Team. Officials who attended to victims were trained, and reviews were conducted to measure the effectiveness of the post-exposure prophylaxis (PEP) programme for victims of rape. Funds had been allocated to fill the identified gaps.

Several Members expressed their displeasure at the outdated statistics, and questioned the validity and usefulness of the report, although they were aware of the fact that the DOH had to rely on researchers. They also noted that the DOH was unable to provide information on bursaries and shortages of health professionals, but received assurances that this information would be sought and conveyed within the next two weeks. The respective roles of the Department of Women, Children and People with Disabilities and the DOH were questioned, in relation to bursaries, training and the database. The DOH was asked to advise on its strategy to improve the shortage of health professionals. Members requested clarification on victim empowerment measures, and questioned whether the rape statistics provided were correct, since the South African Police Service figures were much higher. Members asked if the Gender Focal Point still operated, and how effective it was. Member also considered how research institutions could improve on their delivery of research. They asked whether any training and empowerment of abused women was available at the shelters, pointed out that many women had no choice but to return to abusive situations and wondered why the maternal and child mortality statistics were so high, and what interventions were in place.

Meeting report

Domestic Violence Act implementation report: Deputy Minister & Department of Health
Dr Gwen Ramokgopa, Deputy Minister of Health, and Ms Precious Matsoso, Director General, Department of Health, were in attendance for the first part of the meeting but tendered their apologies for having to leave early.

Ms Matsoso noted that the Department of Health (DOH) had given recommendations on how best to strengthen the health sector so that it could respond to challenges around implementation of legislation such as the Domestic Violence Act (DVA). The DOH needed to make budgetary allocations to respond to challenges of Gender Based Violence. This strategy would be linked to the quadruple burden of disease.

Dr Yogan Pillay, Deputy Director General, Department of Health, presented the Progress Report and stressed that what was reported was actually only the tip of the iceberg. There were much bigger problems than those reported, and government and society needed to respond and intervene together.

He added that in November 2011, these Portfolio and Select Committees had asked DOH to respond to questions relating to psycho-social support, the data-base and training, to follow up on the implementation of the DVA. A report was made on those issues in January 2012. He noted that the quadruple burden of disease (BoD) in South Africa was listed as HIV, Aids and TB; high maternal and child mortality, non-communicable diseases, and violence and injuries. He outlined where South Africa sat in the global burden of HIV infections and listed why the life expectancy in the country was adversely affected by communicable diseases. The Victims / Survivor’s needs in post-rape and sexual assault care were paramount and again listed issues on which the Department would concentrate (see attached presentation for full details).

Psychosocial support was another issue previously raised by the Committees. Dr Pillay noted that the DOH had developed a Human Resource plan for the health sector to identify skills gaps and suggest interventions. This HR strategy would, in turn, identify shortages of health professionals, and it was noted that Psychologists and Occupational Therapists had not been included.  However, the Department was still recruiting these health professionals and placing them in Community Services.  Bursaries had been issued and, whilst the Department dealt with cases of Domestic Violence if court referrals stipulated the need for mental observation, the Department of Correctional Services (DCS) was responsible for the perpetrators of this violence once they had been sentenced.

Dr Pillay confirmed that there was a need for effective databases within and across government departments and so the DOH needed to collaborate with other departments, such as the South African Police Service (SAPS) to ensure these were kept up to date.  The Victims Empowerment Management Team comprised of seven government institutions, and had piloted in a number of interventions in health, police, correctional facilities and shelters which managed victims of violence.  The objective was to have an integrated database accessible to all departments who managed victims of violence.

In regard to training, Dr Pillay tabled a list of the number of health officials trained in specific areas in 2010/11 (see attached presentation). The training of officials who attended to victims was covered by a comprehensive curriculum developed by the DOH. The DOH also conducted reviews for all provinces to monitor and evaluate the progress of the post-exposure prophylaxis (PEP) programme.

Dr Pillay concluded the presentation by assuring Members that the Department was a collaborative member of the Victim Empowerment Management Team (VEP) for empowering victims of violence, the Inter-Departmental Management Team (IDMT) that managed victims of Sexual Assault, and the Inter Departmental Committee (IDC) for the Charter on Victims’ Rights.

Ms Matsoso assured Members that the Department had specifically allocated funds to filling the identified gaps. The DOH had just completed an audit of provinces’ agenda policies, and this would be prepared by April and would show what the DOH was doing to address Gender Equality.


Discussion
Ms P Petersen-Maduna (ANC) noted that the statistics and survey findings quoted in this Report dated back to the period 1997 and 2007. She wanted to know if this information included all the provinces and rural areas. She asked whether the DOH would train those with disabilities when it did its training.

Dr Pillay said that DOH had held consultative meetings in April 2011 on how to improve data on gender based violence.  DOH was also meeting with the South African Human Rights Council and Medical Research Council to create a collective response to this challenge.

Ms S Rwexana (COPE) stressed that women, children and people with disabilities were the most vulnerable people in South Africa.  She asked how the Department planned to provide information to the centres regarding all illnesses.

Dr Pillay said DOH was strengthening primary health care by implementing monitoring, to be done by health care professionals in all districts, around the problems that affected all spheres of society, including HIV, diarrhoea, pneumonia and severe malnutrition. DOH had worked hard and had succeeded in preventing these illnesses, especially in rural areas.

Mr D Worth (DA, Free State) referred to the training statistics in the report and asked why, for example, there were two instances in which the Free State was cited, but Mpumalanga was not mentioned at all.

Mr Joel Mokonoto, Deputy Director, Department of Health, said many provinces had requested training. The double references to the Free State were an error, as one of these entries should have referred to the Eastern Cape.  Training in Mpumalanga had only been done in February, too late to be included in this report.

Ms H Lamoela (DA) asked the DOH to provide a breakdown of the bursaries given, by province, in relation to the training of Occupational Therapists (OTs) and Psychologists. She asked how many of these bursary students had, or were about to, complete their studies, and, if there had been dropouts, how many there were, and the reasons for the dropouts. She also asked if the bursaries were repayable, and whether the graduates were taken into government departments.

Dr Pillay agreed that the presentation seemed to suggest that there was no shortage of psychologists and OTs in the health sector, but this was not correct. The main challenge was the number of posts in the public sector. The HR strategy was presently looking to identify how many specialists were needed for the new service delivery platform.

Mr T Mashamaite (ANC, Limpopo) wanted to know what studies or research had been undertaken since 1997. He also questioned why the DOH did not have the relevant information in regard to the bursaries available at this meeting.

Dr Pillay agreed that he did not have the data on the bursaries and asked for time to gather this information, which would be presented in two week’s time.

Ms Lamoela followed up on this answer, asking if the DOH had successfully created one system accessible to all departments. She asked who would monitor the officials who were trained, and what positions they currently held in the system. She wondered if the vigorous training that had been done prior to the World Cup was still in force.

Mr Mokonoto said this training still existed but they were aware it was not covering the rural areas. 

Ms Lamoela asked if there was any follow up on the care to those affected by violence.

Ms E More (DA) was concerned about the accuracy of the research statistics on gender violence, noting that the SAPS had revealed that the figures were actually far higher. She asked why the Sexual Offences Act updates had not yet been submitted.

Dr Pillay admitted he had no idea as to why this update had not been submitted to the Gender Commission and would provide some insight in two weeks time.

Ms More asked if gender based violence, if still relevant, was being addressed in the course curriculum in addition to sexual equality.

Ms Moe asked for more information about the pilot projects on the data base, particularly the start and end dates.

Ms More questioned whether results were produced; if not, this seemed to suggest that the departments, including the Department of Women, Children and People with Disability (DWCPD), were not being effective. She thought that more visible results were required.


Ms I Ditshetelo (UCDP) was disturbed by the rape statistics, and wanted to know what methods the DOH had devised to bring these down. She noted the reference to pregnancy prevention and wondered if the DOH was also dealing with pregnancy of school-going girls.

Ms Ditshetelo asked what methods the Gender Focal Point used to reach the rural areas, and asked whether the DOH had its pamphlets translated into other languages. She wanted to see the real results of training now, and did not want to have to refer back to answers given in September 2011.

Mr Mokonoto said the integrated committees had introduced the Seven Rights of Crime and Violence victims, and one week in September was designated as Victims Rights week.  Victims were being taught about their rights to treatment.  This included people with disabilities.  He admitted to a shortage of people trained to deal with this workload, especially in the rural areas.

Dr Pillay added that the DOH, at national level, normally published pamphlets in one language and it was up to the different provinces to undertake the translation of these pamphlets. However, there was definitely a shortage of materials in Braille.

Ms M Tlake (ANC) felt that the Gender Focal Point was of no value as it had no decision making authority. She questioned if the Gender Focal Points still existed, asked at what level they were placed, and whether, if they existed, they were making a difference. She also wanted to know if there was any link between domestic violence and the high rise in maternal and child mortality.

Ms N Motlatla, Acting Director, Department of Health, noted that she fulfilled the role as the Gender Focal Point within the DOH. She was also involved with attempting to strengthen child health with the  DWPCD in an attempt to strengthen child health. The two departments had collaborated to integrate healthy lifestyles and to work around issues of domestic violence. The Gender Focal point had five officials and participated within the Department, being placed at directorate level.

Dr Pillay added that a five point plan was in place to strengthen family planning and lower mortality rates, and this was included in the new School Health Plan.  DOH had identified the need to strengthen the school health service, starting with those in the poorest areas.  Mobile units would be taking services to the children.

Ms A Qikani (ANC, Eastern Cape) wanted recent statistics on maternal and child mortality and asked if staff shortages were possibly impacting on these figures. She also asked why the Eastern Cape was not included in the list of provinces where health care training had taken place.

Dr Pillay admitted that maternal and child mortality health rates were very high, and that the Department was addressing the major causes.  The new DOH strategy had identified all phases of a pregnancy and birth, as well as HIV amongst pregnant women, that were major contributors to maternal mortality. Departments and society needed to work together, and more women needed access to early ante-natal care. DOH was providing facilities to deal with problems facing pregnant women before, during and after delivery.

Dr Nat Khaole, Director: Womens and Maternal Health, Department of Health, said that the issue of maternal and child mortality was a very emotional one and reiterated that the DOH was dealing with it. It was recognised that there was a need for training in all spheres. He said the issue of Domestic Violence covered a large area, and that the designation of the “Domestic Violence” Act was a little confusing; it did not only have an impact on matters occurring within homes. The National, Provincial and District spheres within the provinces all had roles to play in implementing departmental policy.

Mr D Kekana (ANC, KwaZulu Natal) wanted to see a preventative approach and more awareness of how to avoid illness. He stressed that many abused women left the shelters or safe houses, and were then forced again to become dependent on the men who were abusing them. He wondered if the DOH offered any counseling or training, perhaps in those shelters, so that the women were not forced to return to the abusive situation.

Dr Pillay said DOH was unable to respond to this, as it was an area falling into the responsibility of the Department of Social Development. He again requested an opportunity to look into some of the specific questions and outline the Department’s responses in two weeks time.

The Acting Chairperson also raised the point that this information was very outdated, which made it largely irrelevant, and asked how this issue would be addressed in the future.

Dr Pillay responded that the Department had consulted with experts in April 2011. Data was available from SAPS in relation to the previous year. However, there was still a challenge in relation to the survey data, which was collated by researchers. The DOH and DWCPD needed to work together to get data that was more up to date.

Ms Lamoela said it was unacceptable that the data remained unchanged, five years down the line, and insisted that new data must be obtained and presented.

Ms More mentioned that the DOH’s continued dependence on researchers for these statistics was problematic, and felt that it had failed to deliver. She noted that the statistics were surely vastly different from those presented.

Ms Tlake agreed with her colleagues.

Ms C Diemu (COPE) was also disturbed by the lapse of time and lack of updated statistics, and felt that the report was unacceptable.

Mr Kekana said that although the availability of researchers had diminished over time, it was unrealistic to depend on researchers as the social problems and rampant poverty needed to be addressed now.

Ms Rexwana added that this report was a result of a collaboration with other state departments, yet none appeared to be capable of doing the necessary research. The departments had to concentrate on fulfilling their specific roles under the DVA and gender-based violence. She noted that since bursaries for training fell under the Department of Higher Education, perhaps a larger meeting was needed to include all those who were accountable.

Ms Lamoela admitted that the DWCPD was also at fault in regard to monitoring, and that researchers were pivotal in supplying different answers. She wondered if the current policies were responding to suspected incidents of domestic violence

Mr Mashamaite asked whether Members were prepared to accept this report.

Ms Ditshetelo said that 80% of the report was “no good”.

Ms Tlake stipulated that health was a major priority in this country and that the Committee needed to interact with the DOH, because, having been made aware of the problems, these had to be sorted out. She thought the responsibility lay not solely with the DOH and said an integrated response was needed.

Ms Lamoela again requested to be provided with a breakdown of trained Psychologists and Occupational Therapists (OTs), and in which province they were placed.

Ms More asked if the shortage of Psychologists and OTs affected the whole country, or just the DOH, and asked for an indication of what was happening in rural areas.

Ms Rexwana urged the Committee and Department to check whether the Minister of Finance’s Budget Speech had alluded to the shortage of researchers.

Dr Pillay answered some of the questions around training in broad terms. He noted that the trainers were meeting requirements, but that the DOH was not monitoring the impact of this training. He agreed that trained doctors needed to be held accountable as well as being monitored and mentored so as to decrease maternal mortality. Chief Executive Officers at hospitals needed to have a certain level of competency, to enable them to manage this. Management of resources was very important, as shown by examples at Baragwanath Hospital.

He added that it was correct that there were insufficient nurses, and that a supply of tutors to train those nurses was needed, but these trainers were hard to find. The DOH was forced to recruit outside the country.  The Department acknowledged that it faced many challenges. He repeated that he would report back on the bursary issue, as well as on other unanswered questions.

The Acting Chairperson agreed that these questions required a response. The Committee Members, in general, were not happy with this report. The age of the statistics meant that the figures quoted were largely irrelevant. Health was a key issue and it was therefore pointless to produce outdated research. However, the Committees did recognise that DOH was forced to rely on other entities.

The meeting was adjourned.

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