Western Cape Health Department 2017/18 audit: Auditor General & Audit Committee briefing, with the Minister

Community Development (WCPP)

26 October 2018
Chairperson: Ms L Botha (DA)
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Meeting Summary

The Western Cape Department of Health (WCDOH) reported that immigration is a challenge affecting service delivery in the Western Cape. The Minister, Dr Nomafrench Mbombo in her opening remarks noted that Statistics South Africa (Stats SA) confirmed that the population in the Western Cape has increased. She added that the DOH is aware that it is serving a large group and that it will never be able to perform at 100%.

Committee members were concerned with the fire prevalence in the hospitals and asked the department to confirm whether the hospitals are fire compliant. Members were also concerned that the reasons given for under-spending on the budget were not satisfactory. The Committee was concerned that the people responsible for implementation of the new Act were not taking the role seriously and that the Department of Health (DOH) was failing the community. Members wanted to know what training had been done for the hospital boards and clinic committees. Committee members asked why there was favouritism in relation to members of the legislature deployed in the hospital boards.

The Minister clarified that the new Act provides that the Minister may appoint members of the provincial parliament who have been nominated by the Committee concerned to hospital boards. She added that the regulations were passed in December 2017 and that nobody has been appointed yet. The DOH confirmed that the full implementation of the Act will take place in 2019.The DOH has budgeted for training and it is waiting for appointments of the board members. The training will comprise clinic committee and clinic managers.

The DOH assured the Committee that the hospitals are fire compliant. They confirmed that they do not have the final report on the cause of the fire at Mitchells Plain hospital. The DOH however speculates that the fire started in the ceiling because of a faulty transformer. The major damage was not due to the fire damage but the water damage during the fire rescue.

On home based care, the DOH reported that it works with a network. The DOH reported that it has intermediate facilities in all geographical areas although there is pressure. On the under spending of R190 million, the DOH reported that R190M is what the department averagely spends in three days, and that the total budget for the department is R22 000 million. The DOH anticipates it is going to lose more money because of a reduction in the budget which forces it to be stringent on the planning of the budget.

The engagement with the department on the Annual Report (AR) was however cut short because of construction going on in the building. Deliberations on the AR was adjourned to another date to be communicated by the Committee.

Meeting report

Ms M Gillion (ANC) asked why the Committee was sitting on a Friday.

The Chairperson responded that it was the only day when the department was available.

Dr Nomafrench Mbombo, MEC for Health, Western Cape, noted that it is the last Annual Report (AR) for the current parliamentary term and thanked the Committee for giving the Department of Health (DOH) an opportunity to account. She stated that the DOH is the largest department across the province in terms of the target market and that it operates 24 hours, 365 days a year, and never closes. Although the DOH has plans, sometimes things like droughts, climate change and disease outbreaks happen which are beyond the control of the department. She stated that the DOH is aware that if people are healthy then the people will be able to contribute towards development of the economy.

The DOH has 2000 staff members in different categories. It works towards alleviating service pressure but it is not able to do that mainly because of immigration. Statistics South Africa (Stats SA) confirms that the Western Cape population has increased. The DOH is aware that it is serving a large group and that it will never be able to perform at 100%. Whilst it may not be able to respond to complaints fast enough because of service distress, the DOH does what it can.

Dr Beth Engelbrecht, Head of Department (HOD), WCDOH thanked the Minister and staff members of the department for their services, and reiterated that serving the public is serous work.

Discussion
Mr R Mackenzie (DA) commented that health workers are underrated and that there is a need to thank them because health workers work in difficult circumstance. He asked the minister to expand on immigration and what impact it has had on the province.

On the Emergency Medical Services (EMS), Mr Mackenzie asked whether there is a formalised plan to address instances when EMS staff have to go to high risk areas. He asked whether there is a plan to assist EMS staff who may suffer from trauma. He noted that in 2017/18 the number of patients transported was reported as 492 303, he requested for the comparative figure for the year before. He noted that the ‘Waste of laundry’ contract was coming to an end and asked what the plan is going forward.

On infrastructure developments, Mr Mackenzie stated that there was a fire at the Mitchells Plain hospital and asked how the DOH is nudging public works to finish the repairs.

Ms Gillion noted that the report had referred to four natural disasters; the fire at Swartland hospital, the severe drought in the province, the devastating fire in the Knysna area, and the severe storm throughout the Western Cape. She asked why the DOH was referring to all four as natural disasters and reiterated that the wording in the AR should be right. She referred to the fire in the hospitals and asked if the departments can confirm whether the hospitals are fire compliant. She gave the example of the doors in hospitals and asked whether they are fire compliant.

On financial constraints, Ms Gillion stated that the spending patterns give a different picture. For programme expenditure, the department recorded an under expenditure of R190.426 million in the 2017/18 financial year. The underspending was attributed to Compensation of Employees (COE) and the majority of IT projects which were in start-up mode. She was concerned that every year the committee hears of financial constraints in the budget and that the reasons given for under spending are not satisfactory. She asked what training is done for the hospital boards and clinical committees. She gave an example of the Khayelitsha hospital where the chairman of the board did not understand his role. She commented that the people responsible for implementation of the law are not taking it seriously and that the DOH was failing the community. She stated that new legislation went through a lengthy process including public participation and cost a lot of money but the difference cannot be seen. She added that there was favouritism in relation to members of the legislature deployed in the hospital boards. She asked why some members are isolated in the appointment of hospital boards and why there is only preference for DA members. She stated that the HOD who is the implementer of legislation must give answers on implementation especially when it comes to training of the hospital boards and clinic committees. She was concerned that the legislation was approved in November 2017 and that it has already been one year.

Ms P Makeleni (ANC) agreed that the department has a lot of challenges in terms of budget constraints coupled with the number of people increasing. She wanted to know what the Minister and the Department have done differently to improve or ‘jack up’ the department. She noted that in the previous year there was a challenge of EMS and staff compliment. She wanted the DOH to explain what it is doing different so that Committee members can be comfortable. She asked how many private hospital applications have been approved in the current year. She asked what the DOH is doing to improve its relationships with the hospital boards and clinic committees. She added that she too was concerned that appointments to the board was not happening to members outside the DA. She confirmed that members are not trying to politicise the issue but to work on bringing everybody to the board. She asked if the relationship between the hospital board and community can be increased in Khayelitsha.

Ms Makeleni referred to the report tabled where the DOH had reported that in 2017/18 there were 92 819 baby deliveries. She asked whether the number includes private hospitals. On the challenges of the previous year, she asked if the DOH had done an assessment to identify which hospitals are worse off and if any mitigation measures have been taken to assist the hospitals. She gave the example of Khayelitsha which was previously allowed to go over its budget. She asked for clarification on page 16 of the report relating to the surplus. She asked how different the private partnerships are and how the DOH is benefitting from these relationships, and if it has any new ones.

Ms M Maseko (DA) noted that the report given to members indicates that the 14.1 million primary care contacts did not include contacts in home and community based care settings. She asked to what extent the DOH is recording home based care and how it uses the information for the benefit of the department. She noted that 94% of complaints were received, and asked what the common complaints are and how the DOH mediates the complaints. She asked for information on the new proposed activities of the home based care and to what extent the DOH was using local content in the running of home based care.
 
Mr P Pretorius (DA) asked for an update on the relocation of Tygerberg hospital. He asked what the current status is and if the stages of planning have been passed.

Ms D Gopie (ANC) asked for more information on the number of children under one year who were fully immunised. The report presented stated that 81.2% children under one year had been immunised in the 2017/18. She asked if the percentage reflected the underspending reported on. She asked the DOH to report on status of ideal clinics. She asked why only 239 out of the 273 conducted assessments. She asked the DOH to provide the Committee with the total number of deaths in the hospitals. She asked the DOH to elaborate on the success and challenges experienced on the Western Cape Rehabilitation Centre (WCRC) and the model being used.

Responses

The Minister stated that the new Act provides that the Minister may appoint members of the provincial parliament who have been nominated by the Committee concerned to the hospital board. She added that the regulations were passed in December 2017 and nobody has been appointed yet. On the Council, she stated that the Minister may appoint one or more council members who have been nominated by the Municipal council. On the chairperson of Khayelitsha, she stated that it will be unfair to speak on his behalf.

The Minister said that based on the review of the Provincial Strategic Goals (PSG) where the DOH is involving other departments, each site being piloted has a HOD managing the site, and thus there was no need to have a strategic coordinator. She added that the DOH will issue the details on the training and all aspects related to implementation of the Act.

The Minister said that the DOH does not have information on how many private hospitals are licensed and that the HOD may send the information to the Committee thereafter.

On the question of what the Department has done differently in the last one year, The Minister highlighted the management efficiency alignment project (MEAP) and the service transformation strategy. The DOH also looks at how it can use technology such as e-prescription to alleviate service pressure.

On immigration, The Minister stated that the DOH does not want to be viewed as xenophobic, it looks at each person as a patient. The DOH does not keep much of the information concerning the immigrants unless if the documentation is required. Because the DOH does home based care, there are areas where the undocumented people do not attend health services as required. Some of the people do not come forward earlier because of being afraid of deportation.

Dr Engelbrecht stated that the EMS has been a concern for the DOH since 2016 and that the DOH had attempted various approaches. There is a plan available where the DOH monitors safety within the vehicles and how emergency responses are managed .The DOH partners with the South African Police Service (SAPS) and the City of Cape Town (CCT). The response time is affected when an area is declared unsafe because the emergency response team has to be accompanied by the SAPS. She confirmed that EMS staff receive post traumatic counselling, and sometimes when staff members are on leave, some of the vehicles are put off the road. Dr Engelbrecht added that communities need EMS the most and that in order to educate the public on the role of the EMS, the DOH has produced a video meant for the public which will be playing all over.

On the question on the 14.1 million primary care contacts, Dr Engelbrecht stated that the head count does not include home based care because it does not reflect the work load. Because of the definition, DOH is not allowed to add the home based care. She added that on an annual basis the DOH puts up a tender advert for people to tender for ‘intermediate care’. She clarified that the 92 000 deliveries does not include private hospitals and home based care, and that Stats SA can confirm on the number of children per house.

On the number of children fully immunised who are less than one year, Dr Engelbrecht responded that it is an area the DOH is investing more on. On mortalities, she said that she did not have the figures. She stated that the private partnerships have been going on for 12 years, and the partnership makes it possible to transfer risk to private parties. The DOH is in the process of planning an exit as it plans for a new partnership.

Dr Laura Angeletti Du Toit, Chief Director: Infrastructure and Technical Management, DOH responded on the drought impact intervention. She reported that there was water security intervention resulting in reduction of water consumption by 30%.This was attributed to awareness campaigns. The second approach involved looking for alternate sources of water, and underground water was considered although in some areas the DOH could not find underground water. The third intervention was the engineering intervention which entailed trying to reduce consumption by using technology to ensure less water is used. On the fires, she stated that the DOH does not have the final report on the cause of the fire at Mitchells Plain hospital. The DOH speculates that the fire started in the ceiling because of a faulty transformer. The major damage was not due to the fire damage but the water damage during the fire rescue. The water caused huge damage to the floor. The contractor is on site and plans to complete in the next quarter. On the Swartland hospital, the contractor has been appointed, work is almost complete, and the DOH is working to restore capacity of the hospitals. She stated that compliance with fire is a top priority. There is physical compliance and safety compliance, and the fact that there are no causalities shows that the DOH is fire compliant. On the quality of the doors, she stated that the doors must stand for two hours before being damaged by heat. The DOH ensures the technology is according to regulation. The fire regulation was recently changed, and the DOH is trying to catch up. On Tygerberg, she clarified that there are two projects, one involves building a new hospital on the one side, and the old hospital will be handed over to public works.

Dr Engelbrecht said that the ideal clinic is a progressive journey. The DOH had 38 ideal clinics last year, and this year it has 196. The progress is at 55%. There is improvement and strong commitment. Most of the challenges relate to infrastructure. On complaints, she reported that there is one complaint for every 3000 patients seen. The main reason for complaints relate to funds, seeing a doctor, and the pharmacy.

Dr Keith Cloete, Chief of operations, DOH added that the DOH is trying to improve quality in the emergency centres. The attempts by the DOH to deneutralise the emergency centres has been overtaken. In the ward there are ill people and the hospitals have to discharge people earlier in order to make space for new ones. The DOH has strategies and considers reports from all the hospitals. The DOH has a network that it works with on home based care. It has intermediate facilities in all geographical areas although there is pressure. On the question of how the DOH is investing in local organisations, he confirmed that the DOH has footprints. It works with local organisations and has contact within the communities. In some rural areas it is difficult, and in other areas there are organisations that cover two or three towns.

Mr Andries Van Niekerk, Chief Financial Officer (CFO), DOH responded on the under spending of R190 million. He stated that the total budget for the department is R22 000 million and that R190 million is what is spent in three days. The DOH underspent on construction and on IT projects. He added that the DOH has been losing about R220 million in the last three years and it is going to lose more money in anticipation of a reduction in the budget. The DOH thus has to be stringent in planning the budget. The DOH reviews all the structures, works to reduce the administration staff and tries to keep vacancies vacant as long as possible. He confirmed that there are also accruals of about R168 million comprising invoices which the DOH has not paid. Whatever the DOH underspends, it keeps and remains as the department’s money. He reiterated that due to the national economic situation, next year will be a hard year.

Dr Engelbrecht confirmed that the money which was not spent has been rolled over into the future.

Dr Angeletti Du Toit added that maintenance is implemented by Public Works and there were consultants’ delays in contract awarding.

Mr Andre Luch, an official from the DOH added that the DOH is engaging with Non-governmental Organisations (NGO) and it will also have an engagement with the boards on the review of private orientation. The full implementation will take place in 2019. The DOH has budgeted for training and it is waiting for appointments of the board members. The training will comprise clinic committee and clinic managers.

Dr Engelbrecht clarified that all the boards have been oriented on the Act but what the DOH wants is deeper training.

The Chairperson communicated that after deliberating with other Committee members, the meeting will be adjourned because of the construction going on which was making the room not conducive. She added that communication will be sent as to when the AR will be deliberated on.

A member of the public asked that the Committee should make sure members of the public are reimbursed for the costs incurred.

The Chairperson responded that she will discuss with the organisers after the meeting is adjourned.

Meeting adjourned.

 

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