Taking Parliament to the People 2016: responses by Eastern Cape Departments of Health & Social Development, with DSD Minister and DoH Deputy Minister

Meeting report

Department of Health: Eastern Cape challenges and successes

Dr Joe Phaahla, Deputy Minister of Health, gave an overview of the input of the National Department of Health (DoH)  in the provinces, and asked the Member of the Executive Council (MEC) for the Eastern Cape to brief the Committee on the efforts made to address the challenges identified during the Committee’s oversight visit to facilities in the Eastern Cape Province.

The Chairperson said she had heard that a lot of work was being done in the Eastern Cape, and requested the provincial Department of Health (PDoH) to describe some of the programmes that it had implemented.

Dr Pumza Dyantyi, Eastern Cape MEC for Health, said that under the integrated school programme, the DoH had a strategy to curtail teenage pregnancies. The programmes initiated two years ago had yielded fruit, as teenage pregnancies had dropped drastically in schools. She cited the example of a school that had 67 pregnant students two years ago, while currently they had only two reported pregnancies. There was a problem with staff shortages, which was caused by a skewed mixture of skills. This meant that there were more general nurses than people with specific skills. There were quite a lot of unemployed nurses. Nurses were no longer leaving in large numbers, but there was an excess in the number of general nurses. A lot had been done in the province by the PDoH, and a state of the art facility had been opened recently.

The PDoH said it had adopted the approach of maintaining and providing infrastructure for existing facilities rather than building new infrastructures. A lot had been done on the facilities that the Committee had visited during its oversight, as well as at other facilities. There were ten facilities that were not yet connected to the Eskom grid. PDoH intended to invest R2.1b in Alfred Nzo over the medium term strategic framework (MTSF) period. The PDoH did not procure equipment on an item by item basis, but on a framework, using tenders to procure groups of equipment, and any facility could procure using the framework. The PDoH was focused on resolving particular clinical health problems and had procured equipment for it. There were existing tenders for facilities for the procurement of diagnostic and imaging equipment, and money had also been set aside for the procurement of equipments for hospitals. Diagnostic and medical imaging equipment had existing tenders for their procurement. A procedure had also been put in place for medical gas piping and installation. Other categories of medical equipment were being purchased or planned for. There were interventions to create more bed spaces, support was available for critical injury facilities, and security to protect the medical equipment from theft was also in place.

The sector had to internalise maintenance so that facilities were able to deal with their day to day maintenance while other serious things could be handled at a provincial level, to avoid bottlenecks in the maintenance process. The PDoH had put a strategy in place to achieve efficient maintenance of facilities, moving away from a crisis management approach. The three facilities visited by the PDoH were the Lugangeni clinic, the Maluti community health centre and the Mpetsheni clinic. The medium to long term plan was to replace the structure in Lugangeni clinic, but a service provider had been secured for minor maintenance work at the facility. A three-phase approach had been put in place to address the issues found with Maluti community health centre. The Mpetsheni hospital had not received as much attention as the other two as a result of an omission on the part of the Department, but it had now engaged service providers to deal with all the infrastructural challenges as a matter of urgency. The service provider was expected to commence work on the week of 16 October and finish by the end of November. The greatest challenge in Mpetsheni was that it was not close to the Eskom grid, and was therefore lacking an electricity supply. The PDoH would engage the services of secure and easy to maintain solar panels. A progress report on the work done in these hospitals would be submitted to the Committee before the end of October.

Dr Dyantyi added that there were currently nine facilities without electricity and the Department was trying to get solar panels, though Eskom kept promising and giving hope for an electricity connection.

Discussion

Mrs L Zwane (ANC, KwaZulu-Natal) suggested that it would save time if hospitals could handle tenders on their own, rather than relying on help from outside. She asked if there was an over-production of nurses in South Africa, based on the statement of the MEC. She expressed concern about how the PDoH handled planning, and asked why the realisation of the challenges of electricity happened only at the implementation stage. Planning for building facilities ought to have involved all the stakeholders from the beginning. However, she commended the PDoH on its success in curbing teenage pregnancies and hoped that other Provinces could learn from the strategy.

Ms T Mampuru (ANC, Limpopo) said the NCOP was mandated to protect the provincial interests, and expressed concern about the NCOP being undermined when they were not notified, when notable events on which its Members had expended their time became successful. She asked for the number of professional nurses that were available in the provinces, and their specialisations. She said that nursing colleges needed such information to strategise on the specific specialty of nurses to be trained. She asked what the Department was doing about risk management and security and also what it was doing on the issue of infrastructure.

Chairperson said the interest of the Committee was on making changes that were obvious. She appreciated that the PDoH had responded to the findings of the Committee by prioritising the clinics mentioned. She said security was sometimes not provided by the PDoH, and sometimes there were too few security officials in the facilities, which gave room for theft. The Department had to develop a new strategy to handle security issues, because it would pay almost double when using private security. She also commended the joint work done by PDoH and the Department of Education to reduce teenage pregnancies. She asked why only one company was allowed to supply maintenance equipment. She recommended that there should be more than one company to guard against exploitation and disappointment, as had been experienced by some other Provinces. She recommended that priority should be given to women in cleaning and cooking as a means of empowering them, because women were the majority. She concluded that a progress report on the issues raised in the meeting would be requested from the PHoD.

Ms Zwane asked for a detailed report itemising what had been done, in line with the required budget. She said the NCOP would be inviting Eskom, because it was not good to have schools and clinics without electricity.

DoH Response

Dr Phaahla said there had been a decision to move nursing training into the universities. The reduction of training in the nursing colleges had led to a progressive over-production and over-employment of professional nurses over mid-level nurses in the public sector. The private nursing colleges had taken over the challenges of producing mid-level nurses, leading to the higher production of mid-level nurses, although the product of the private colleges had limited practical skills. There was an ongoing work to address the situation.

He agreed that the Department could not continue with outsourcing of security, and the finalisation of the strategy towards in-sourcing was on the way. Some of the challenges that the Department must plan for was that that during the public sector strike, it might include the security and the Department would need to mitigate the risk that would be caused by such action.

Dr Dyantyi apologised for not inviting the NCOP Members during the launching of the facility, and promised to invite them in future. They were not building new clinics except for the places where there were mud structures. She would welcome the intervention of the NCOP to resolve issues with Eskom. The PDoH would report back to the Committee on the other issues.

The Chairperson said the invitation requested was not just for ribbon cutting, but the NCOP had also missed an opportunity to view the facility. She said the Department had not talked about their successes. She recommended that the Department should pay a visit to Singapore to learn how it could optimise the facility that was launched. She said the Department does not need big companies for sewing, and this would provide opportunities for women to be empowered. The Department should go and clean up its report. She thanked the Department for making time to attend, and discharged the delegates.

Department of Social Development (DSD): Early Childhood Development (ECD)

Ms Bathabile Dlamini, Minister: Department of Social Development (DSD) said there was an agreement to start renovation of Early Childhood Development (ECD) facilities in the poorest areas. The DSD would be renovating structures and not building new structures, because building structures was the responsibility of the Department of Public Works (DPW). The National Development Agency (NDA) had been identified to help with capacity building. The challenge experienced previously was that training of practitioners was done by the Department of Education, and it appointed service providers but did not keep proper records of the service providers it appointed. The audit had been done but was currently being repeated because the early childhood development (ECD) facilities had provided numbers that did not tally with the attendance of the children attending them.

The DSD was focusing on the improvement of the infrastructure in the ECDs. Another area of importance was that resources for training should be shifted to the Department of Higher Education. The DSD had worked with the Department of Basic Education on structuring the curriculum. There was a collective agreement on the report of the Department. There was an agreement that provinces must meet twice a month to address challenges, which was a step towards ensuring the success of ECD facilities.  The DSD would also like to accede to what it had committed to -- that was to be committed to the first 1 000 days of the child, which was an instrument used by the UN to ensure that the rights of the child were respected.

The Chairperson said it was not only infrastructure that was important, but also the curriculum. She suggested that there should be a joint meeting with the Department of Basic Education to resolve issues of responsibility. What the children were being taught varied greatly across centres, and facilities in the Eastern Cape were in bad shape. She observed that some ECD facilities were located in mud houses and shacks etc. She recommended that if DSD was to build, it must consider building proper facilities.

Ms Nancy Sihlwayi, MEC: Provincial Department of Social Development, Eastern Cape, said one of the issues was having social workers that would be able to give social support. She said 100 social workers had been recruited from the Department’s database of trained social workers. It was not possible to employ all the social workers that were trained because of financial constraints. Some of the employed social workers had declined the employment offered because of the area to which they had been deployed to work.

She said the Department had adopted schools with a low pass rate and had sent some of the social workers that were employed to these schools. The intervention at these schools had yielded results, because the performances of these schools had greatly improved. The Department was on track in engaging young people and women. The area of challenge was disability. The challenges of ECD facilities were not limited to infrastructure, although the standard of the infrastructure needed to be upgraded, but some ECD facilities were located on private properties. R8m had been budgeted to renovate ECDs in 2016.

There was a programme to address substance abuse, and the tools being used to address this issue had been made available by the NDOH. Successes had already been achieved, and a provincial drug master plan had been launched to establish a structure which brought all stakeholders together to address the challenges of substance abuse. To achieve the vision which talked about the vulnerable society, the Department had considered how to address domestic workers and farm workers.

Mrs Ntombi Baart, Head of Department (HOD), DSD, Eastern Cape, said serious infrastructure challenges had been identified the NCOP during its oversight visit. The Department had started using its equitable share to renovate infrastructure, though it was not within its mandate to fix infrastructure. It needed to ensure that the centres were registered, and without the proper infrastructure it could not register them, hence the ECD infrastructures were being renovated by the Department. The national Department had budgeted R12m for the renovation of ECDs during the 2017/18 financial year.

She said there were issues when the conditional grant affected the number of children that were being subsidized, but there was an increase in the number of children subsidised. Project managers had been appointed for the renovation of the infrastructures. There had been an increase in funding, with R12m for infrastructure and R44m for the expansion of ECDs. The fund had not been accessed because of ECD’s challenges with registration and curriculum. The Department was financing 1 727 ECD centres with voted funds and 833 centres with conditional grants. Children from disadvantaged areas and poor students were prioritised in the use of the conditional grants.

Discussion

Chairperson asked for advice from Members on what should be done about the report details that were not made available by the Department. The people of the Eastern Cape would demand to know the details of the meeting.

Ms P Samka (ANC, Eastern Cape) said although the absence of the information was disadvantageous to the Committee, but it would be acceptable to get a copy of it at a later time.

Ms Zwane asked for clarity on the ECD structures falling within the jurisdiction of the Department of Public Works.

Ms Baart said she had made a mistake earlier, as that infrastructure fell within the purview of local government.

Mrs Zwane asked if the service providers used for training provided were accredited. What module was being used for training in the ECDs, because there were several modules? Some of the ECD centres’ structures were not up to date, and she asked if the ECD facilities with bad structures were denied registration or if they were registered temporarily, pending their refurbishment. She also asked how the Department dealt with situations where the number of ECD facilities exceeded what could be accommodated by its fund.

Mr M Khawula (IFP, KwaZulu-Natal) asked if people who were trained by the Department were kept on its database and employed, commenting that this could be a sort of discrimination against people who were trained by sourcing their own funds. He asked for clarity on who provided the structures. There was a challenge in identifying which Department should be responsible for certain infrastructures, because many departments budgeted for infrastructure maintenance.

Ms Zwane said some of the ECD centres said they always had to wait for the payment of subsidies, and she asked the Department to explain why this was the case.

The Chairperson government had prioritised ECD centres, but the Committee would like to prioritise government’s ownership of structures so that it could have control over them. The government should make a provision for structures, using the right mechanisms. It would be important to know the number of ECD centres that belonged to the government, and how many were NGO-based. All the centres were receiving late payments because they did not have the considerations for registration, such as curriculum and structure, and they depended on government to provide these facilities. Also, the role of the national Department should be to train workers, and provinces should budget for the absorption of the social workers that were trained by the national Department. The Department must consider those trained privately by their parents. She concluded that most of the observations were inputs, and she would want the Department to include them in its plan and future report.

Minister Dlamini said the Department had focused on renovation. It had started a programme called ‘adopt an ECD,’ which helped to build ECD centres through the National Development Agency (NDA). The ECDs that did not meet the registration requirements were not closed, but the Department assisted them by providing facilities and awarding them a temporary certificate. Issues of locating ECDs close to one another would be looked into by the Department. The government had declared social workers as a scare resource, and the Department had started training social workers, but there was no funding for the absorption of the trained social workers. The money used to pay the employed social workers now was the R500m meant for further training of social workers. The Department did not have sufficient social workers to deal with the issue of alcohol and substance abuse. It would in future consider employing social workers sent to the schools by their families, as suggested by Members of the Committee. The Department builds when it had funds, and if the government builds an ECD it was a non-profitable organisation. She added the Department was working with Basic Education on the issue of curriculum.

Ms Sihlwayi said some of the issues were that cooperatives were willing to be involved, but there were so many bottlenecks that the Department was dealing with one at a time. Some of the causes of delay were that some ECDs had problems with their books. There was a need for social workers to be on the ground to help the ECDs with their financial reporting.

The Chairperson thanked the DSD for making time available, and said she hoped that the Department would make a difference. She appreciated the work that had been done so far. The Committee was supposed to adopt a report, but it did not have a quorum and the adoption would have to be done some other time.

The meeting was adjourned.