The MEC and Head of Department for the Limpopo Department of Health gave a progress report on issues highlighted as major concerns by the Committee, when it had visited the Department of Health in Limpopo in January 2011. Since that date, the Department had been placed under administration and a new MEC had been appointed. The MEC indicated that there had been success in some areas, and outlined that the areas of improvement included the recruitment and retention strategy for staff, the functioning of the Mental Health Boards, and some improvements to the facilities, although there was a concession that these were not yet up to scratch. A major problem remained the lack of funding. Although the national Department of Health had made some further allocations, these were not sufficient to meet all the mandate and the provincial Department had been forced to prioritise those issues that it considered “non-negotiable”, which included patient nutrition, blood, laboratory services and other essentials. There was a shortage of drugs, but this was exacerbated by a national shortage, and of ambulance services.
Members had mixed reactions to the presentation; the Chairperson congratulated the Department on the achievements that it had made, but other Members felt that not only had the presentation failed to address some issues that were of specific concern to Members, such as infrastructure, there was still not enough proof of improvements. Questions asked related to the state of the facilities, including staff accommodation, which in turn affected attraction and retention of staff, the main reason for resignations, whether rural allowances were paid, and whether sufficient medical equipment and ambulances were available. The contract and terms with LifeCare for some hospitals was questioned, as well as the numbers of patients who were accommodated at each facility. Members wanted to know about the Department’s interaction with the mental health boards, how the Department encouraged families to be involved, how it handled “unknown” patients, and whether it ensured that child and adult patients were kept separate. The funding challenges were examined in greater detail, and the reasons for revitalization of the institutions was also questioned. The Department requested that the problems with lack of funding and ambulance shortages should be brought to the attention of the President.
Limpopo Provincial Department of Health progress report on issues isolated by Committee during oversight visit in 2011
The Chairperson reminded Members that the Committee had done an oversight visit to the Limpopo Provincial Department of Health (the Department) in January 2011. There had been two main objectives; firstly, to investigate the allegations of neglect and inhumane living conditions of mentally disabled patients and, secondly, to investigate the plan of action and interventions by the Limpopo Provincial Department of Health to address the problems.
Mr G Mokgoro (ANC, Northern Cape) wanted to know if the Department was under administration.
Mr Norman Mabasa, MEC for Health, Limpopo, agreed that this Department was still under administration. At the time of the Committee’s oversight visit in 2011, there was a different MEC heading the Health portfolio and it had not yet been placed under administration.
Ms Daisy Mafubedu, Head of Department, Limpopo Provincial Department of Health, briefed the Committee on patients living with mental disabilities in Limpopo, taking Members through the presentation page by page.
Presentation by the Limpopo Department of Health
The purpose was to brief the Select Committee on Women, Children and Persons with Disabilities on the issues that were observed during the committee’s oversight visit. These issues included; the lack of a skills retention strategy of the Limpopo Provincial Department of Health; concerns over the absence of the mental health review board; the extent of family involvement in the lives of disabled patients at the Evuxakeni Hospital; poor referral systems; and poor condition of facilities particularly for the mentally disabled patients at the Evuxakeni Hospital.
The briefing comprised of a background and an outline of the services provided at Evuxakeni, the skills retention strategy which was being applied by the Department, an update on the Mental Health Review Boards, family involvement, referral system and the state of the facility.
The Evuxakeni Hospital was opened in 1985. The services provided at the Hospital included acute psychiatric services, sub-acute psychiatric services and chronic psychiatric services. On the skills retention strategy, the Department had developed a Skills Recruitment and Retention Strategy, which was approved. However it was not fully funded and therefore it was partially implemented. The Department continued to address the issue of health professional shortages through direct intakes and accommodation for health workers was prioritized through the Housing policy that favoured obligatory staff.
The Mental Health Review Boards were appointed in all 5 districts in the province, since April 2011. The Mopani Mental Health Review Board was a highly active structure that enhanced the services of Mental Health in district and the board held its meetings regularly as programmed.
With regards to family involvement, approximately 60% of families involved themselves with the disabled patients and mental health care users. These patients visited their families. However there were challenges such as stigma and crime that may have been committed by the patient while sick that prevented the patients from undertaking these visits. Some patients remained unknown, despite efforts by Social workers to trace relatives. Such patients remain institutionalised for years.
On the state of the facility, the Committee was told that the facility was 28 years old and in need of revitalisation. The institution was scheduled for revitalisation during the 2013/14 financial year, however it had to be postponed in order to accommodate the construction of Siloam Hospital as a National Presidential priority project. The health brief and business case was still going to be undertaken during the 2013/14 financial year.
Mr Mabasa noted that the three hospitals in Limpopo for persons living with disabilities were becoming overcrowded. The Department, meanwhile, faced another challenge in that there were severe constraints to its infrastructure budget. There was also a shortage of psychiatrists in the facilities.
The Chairperson said that the Limpopo Province was likely to produce the best academically-qualified disabled people, as it had the first computer laboratory that accommodated those with disabilities. She questioned the challenges around the recruitment and retention strategy.
Mr Mokgoro also wanted to hear about the recruitment process.
Ms Mafubedu noted that the Department had been successful in the sense that it had improved in recruitment, but there were still instances where staff would leave in larger numbers than they were recruited. The Department ideally needed all recruitment to be fully funded. If the issue of staff accommodation were also addressed, this would ensure that Evuxakeni was able to retain more staff.
Mr Mokgoro asked what was the main reason behind staff leaving.
Ms Mafubedu said that within the health sector, the Department used to believe that increasing the salary of the healthcare workers would prevent their resignation. However, it had now realized that their working and living environment were the main factors influencing their decision to stay or leave. Another major factor was the availability of schools for their children, and of entertainment facilities in the locality of the hospital.
The Chairperson said that certainly monetary remuneration was also a contributing factor when it came to retaining staff, as doctors working and staying in rural areas did not enjoy the same privileges of workers in the urban suburbs. She asked if there was some incentive or allowance for healthcare workers in rural areas.
Ms Mafubedu responded that there was indeed an allowance for healthcare workers in rural areas, which formed part of the Department’s recruitment strategy. However, there were some inconsistencies as exactly the same allowances were awarded to those who were closer to the towns. For this reason, workers would obviously prefer to seek work in areas that were closer to the towns, rather than quite far away. This was something where perhaps the Committee could raise the policy issue with the Executive.
Mr Mokgoro said that the Committee had expressed strong dissatisfaction with the state of the facilities, after its oversight visit in January 2011. The building was highly inappropriate, with patients enduring quite filthy conditions. He noted that the current presentation did not mention anything about the facility’s status at this stage and this should have been detailed. He asked if these facilities also now had sufficient medical equipment, medical supplies and ambulance vehicles. He further wanted more detail on the status of the accommodation for the healthcare workers at the present time.
Ms Mafubedu confirmed that the status of the buildings had improved, compared to its status during the oversight visit. She said, however, that there were still shortages of medical equipment, medical supplies and even ambulances. The facilities would ideally need 100 ambulance vehicles per year and the budget only allowed the Department to run 30 to 31 vehicles.
Mr Mokgoro wanted to know what the role of LifeCare was in the lives of the mentally disabled patients. He asked what the Centre referred to on page 4 f the presentation had been, prior to the Department converting it in to a psychiatric hospital.
Ms Mafubedu explained that LifeCare was a private entity, and when it was established in Evuxakeni Hospital during 1985, it had mainly catered for patients living with disabilities. This had not been a fully-designated psychiatric hospital at this stage. In 2005, the hospital was made over to the Limpopo Department of Health.
Mr Mokgoro asked if any payments were charged to patients.
Ms Mafubedu said that there was an agreement between LifeCare and Government, where Government provided the institutions with a subsidy, depending on the number of patients.
Mr Mabasa explained that the previous MEC had signed a 25 year contract with LifeCare and when the new MEC took over, there was no option but to continue this contract.
Mr Mokgoro then referred to point 4 on page 1, and asked if the hospital had increased or decreased the number of beds for patients, and how many it could now hold.
Ms Mafubedu said that the legislated number of beds in a facility was 400 but there were currently less, because of the limited space.
Mr Mokgoro asked if the Department had any interaction with the board, and, if so, what the purpose of this interaction was. He asked how often the board held meetings, and what further communication happened between the board and the Health Department after these meetings.
Ms Mafubedu said that there were two categories into which the Mental Health Boards were divided. The first was the Hospital Board, dealt with governance issues and the second was the Mental Health Review Board, which basically dealt with the reviewing of patients, and which met more frequently. There was a similar composition in these boards. Over the past year, the boards had held meetings every week, on a Wednesday.
Mr Mokgoro referred to the first point on page 9 and wanted to know what exactly the family’s involvement was, and what the families were doing to help the Department or patients. He had understood that all patients were required to fill out an admission form, and this should be safely filed, so he wondered what would happen in regard to the admission records for “unknown patients”.
Ms Mafubedu explained to the Committee that the Department advised families that they should be fully involved in the patient’s life, as this would help the patient to become de-institutionalised. The Department actively encouraged families to ensure that patients took home leave and this would gradually lead to patients being able to move back home permanently. However, there were still some families who did not visit or were not prepared to be involved at all. Some patients faced stigma at their homes, and for those who had committed a crime, they may not be permitted, or encouraged by the families, to return home.
She said that in cases where the patients were classed as “unknown”, this would be reflected on the admission records. In the majority of cases, the hospital was not able to ascertain their identity, although there had been one instance where a family had traced the patient.
Mr Mabasa said that the problem with unknown patients did not only exist within psychiatric hospitals and said that he had suggested to the Department of Safety and Security that it should implement a fingerprint system for admission of patients.
Mr D Worth (DA, Free State) referred to page 5, and wanted to know how the Department ensured that the paediatric patients were separated from the adult patients. He was concerned that Sub-acute patients were mixed with the acute patients, but he was aware that this was due to limitations of space.
Ms Mafubedu confirmed that the Department would like each and every hospital to have an acute ward.
The Department ensured that pediatric patients were separated from adult patients, and that males were separated from females at all times.
Mr Worth also wanted to know how much the Department had budgeted for psychologists, occupational therapists and physiotherapists.
The Chairperson wanted to know what national or provincial government was doing to assist the Department, and if these interventions were satisfactory. The Chairperson also wanted to know what intervention the Department would like to see from the Committee.
The Chairperson mentioned that before the oversight visit, issues of disabilities were being neglected, and she was happy that the situation had now improved. She was also pleased to hear of improvements in the Mental Health Team and the fact that the board was now functional.
The Chairperson acknowledged that there was a challenge in recruiting doctors and nurses, because of the distance they would have to travel and also their poor living conditions, and she was pleased to see that there were some improvements here. She also said that the referral system turnaround time had also improved tremendously, and commended the Department for this.
The Chairperson noted that there was still a problem with funding and wondered what the Department was prioritising.
Ms Mafubedu said that even after the Limpopo Department clearly pointed out that the budget it had been given was inadequate, the Department still failed to get additional funding. For that reason, the Department had been forced to prioritise. It had isolated fifteen “non-negotiables” which included the laboratory services, bloods,blood gasses, and food for patients. She noted that if, during the current financial year, any of the support staff were to leave, the Department would not have the funds to replace them, because some of the support staff funding had already been shifted to recruit professional staff such as doctors. The shifting in funding still did not answer all the problems, and the Department still needed extra funding. The prioritisation had also taken the form of some of the institutions getting more funding than others. Food was fully covered, but the Department was still short on medical supplies.
The National Department of Health had secured R15 million rand to assist the Limpopo Department of Health, and another R100 million was also expected.
An ANC Member referred to the second point on page 11 and wanted to know about the postponement of the revitalisation of the institution.
Ms Mafubedu said that during a public meeting in July 2011, the Department was told that the money was available but that the Department must initiate the project. The provincial Department had therefore begun to plan for implementation of the project. The plan of action was drawn and forwarded to the Director General of the National Department of Health, and requesting a transfer of funds in this financial year, which would have enabled the project to begin. However, no positive response was given. This meant that the provincial Department again had to try to prioritise aspects of its own budget allocation, making provision for the construction of the Siloam Hospital. The additional grant for infrastructure was cut by almost half. The provincial Department had been told that the funds would be centralized so that the project would still be able to run.
The Chairperson and other Members said that this was a matter that needed to be brought to the attention of the President.
Mr Makumele wanted to know if the ambulance service has a working telecommunication system.
Ms Mafubedu said that the current telecommunication system was not efficient and added that there were some irregularities which need to be checked.
Mr Mabasa also noted that the budget for the Department of Health in Limpopo was relatively low compared to other provinces, at around R500 million per year, compared to Gauteng’s budget for health of R8 billion and Western Cape was at around three and a half times more than Limpopo. Besides the challenges that the Limpopo Department was facing with regard to medical drugs, there was also a shortage of drugs nationally.
Mr Mabasa requested that the Chairperson raise concerns about the ambulance situation in Limpopo to the President. These ambulances suffered greater wear and tear than in other provinces, because of the gravel roads.
Mr Mokgoro expressed that he still had concerns arising from this presentation. The Committee could already see, in January 2011, that this Department was heading for the stage where it must be placed under administration. He did not think that today’s presentation gave any clear indication of whether the Department would get to the stage where it could function independently again. He asked if there was any light at the end of the tunnel.
Mr Mabasa said that there was indeed a light at the end of the tunnel. The Limpopo Provincial Department was fully aware of its problem areas, was addressing them and knew how to move forward.
Mr Mokgoro suggested to the Chairperson that the Committee make a follow up visit to Limpopo and come back with further recommendations for Parliament.
The Chairperson congratulated the Department on the progress that it had managed to make.
The meeting was adjourned.
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