The Committee was briefed on the Matlala Petition This petition called for the intervention of the NCOP (National Council of Provinces) in relation to the alleged failure by the Limpopo Department of Health to honor its undertaking of building a Health Care Centre for the community of Dichoeung in June Furse, Limpopo.
Members were concerned about the way the community had been treated, as not only had the Department failed to honor its undertaking of building a Health Care Centre, but the community had not been informed about the situation, and, the Department had built a clinic in another village - Madibong - with the same name as the affected clinic committee - Dicheoung Clinic.
The Committee asked how it could happen that the Department had built a clinic in another village – Madibong - and that clinic was also called the Dicheoung Clinic. The overriding concern was that the Department had not even listened to the community and had also waited so long without sending mobile clinics to these rural areas. The Committee also noted the lack of staff in the old Dichoeung Clinic, enquired about staff numbers in the clinic; the distances between the old and new clinics; and whether the clinics were in the same ward.
Members heard that the affected Clinic Committee had met with the Minister but had rejected the Minister’s proposal to engage with the Limpopo Provincial Department of Health directly citing a loss of confidence. Members felt that the NDOH had not disclosed all the relevant issues that had been discussed in the engagement with the petitioners; and did not want to commit themselves to certain issues that were discussed previously with the provincial department. The resultant lack of information was confusing Members. The Committee bemoaned the absence of the MEC of Health in Limpopo to provide an explanation as to why they have built a clinic in Madibong village with the budget that was meant for Dichoeung Clinic, and still called the new clinic the same name.
Members expressed their disappointment with the presentation of the NDOH as they had received the petition in 2016 and nothing had been done. The Committee asked: ‘Why should the issue of identifying a site take so long’? Because communities could decide for themselves where they wanted their clinic to be situated. Members emphasised that one cannot have development without meaningful community participation. They said: ‘The Department needs to go through its plans with the community and not just involve the community at the tail end of development processes’.
Another serious concern for the Committee was the late arrival of the Deputy Director-General: Health Care Services: Limpopo Province Department of Health. Added to this was the fact that this official was without a presentation on the provincial take on the issue. The apology and excuse for lateness from this official was not accepted by the Committee as they felt proper planning and time management would have averted the delay. Members reiterated the fact that the ‘very important basic services from a health facility needs to be taken seriously because it affects the lives of their people’
As a way forward the Committee resolved to go to Limpopo province. The Committee resolved to ‘communicate on time’ with all the relevant stakeholders and to make sure that the MEC of Health in Limpopo was present in that meeting. This will be a fact finding mission that will be directed at the Limpopo Province.
The Chairperson welcomed all present in the meeting. She said the purpose of the meeting is the consideration of the Matlala Petition (Petition calling for the intervention of the NCOP, in relation to the alleged failure by the Limpopo Department of Health to honour its undertaking of building a Health Care Centre for the community of Dichoeung in June Furse, Limpopo).
The Chairperson read apologies received from: Mr A Gxoyiya (ANC, Northern Cape) and Mr I Seleku (ANC, Western Cape).The Committee accepted the apologies.
The Chairperson said that there is one item on the agenda: the consideration of the Matlala Petition (a Petition calling for the intervention of the NCOP, in relation to the alleged failure by the Limpopo Department of Health to honor its undertaking of building a Health Care Centre for the community of Dichoeung in June Furse, Limpopo).
The Chairperson said that the petition they were dealing with is from the Dicheoung Clinic Committee who has written to this Committee and asked for assistance. After the petitioner the Committee will allow the National Department of Health (NDOH) to make its own presentation in this regard. The Committee was also expecting to receive a briefing from the MEC of Limpopo Provincial Department of Health (LPDOH), but it was told that the MEC will be sending someone else to this meeting and that person had not yet arrived as yet.
Mr Elcort Matlala, Secretary: Dichoeung Clinic Committee, thanked the Committee for the opportunity to present their petition. The petition was written on the 29 August 2019. Their primary complaint in this petition is that there was a commitment by the Limpopo Provincial Department of Health to build a health care facility in the 2018/19 financial year. Subsequently it was changed without any communication to them as the community of Dicheoung. They only learned about it when they found it in the district municipality IDP document that it had been moved to the 2019/20 financial year without any reason being provided. However, they had seen that it was in the middle of the financial year and nothing had been done and no communication had been made with them. So their efforts at communicating with the Department drew a blank. And it was also difficult for them to trust the Department any further because during one of their engagements with the Department they were told that the MEC said it has moved the building of the Health Care Centre to the 2019/20 financial year because they will not build the facility in 2018/19 because of budgetary constraints. This made it difficult for them to trust anything that came from the MEC of Health in Limpopo.
Therefore, this is why they had decided to write this petition and request an urgent response because the 2019/20 financial year is ending next month, and nothing is being done or communicated with them in this regard.
Ms S Shaikh (ANC, Limpopo) said she noted that what has been presented is that there has been a lack of funds from the Department’s side. She asked whether there are any other reasons the Department had given the petitioners for their behaviour.
Ms M Mmola (ANC, Mpumalanga) said that what she noticed in this petition is that the Department had built another clinic in another village of Madibong, and that clinic was called Dicheoung Clinic. She asked how that could happen.
Ms C Visser (DA, North West) said it can be seen in the petition that communication with the Department had started in 2007, and now it’s 2020, yet nothing has been done in that area. And they should know that their democracy is built on public participation. She asked why the Department had not listened to the community, and why has it waited so long without even not sending mobile clinics to these rural areas.
The Chairperson interjected and said that that they should park Ms Visser’s question and deal with it when they interrogate the Department because they were asking questions of clarity to the petitioner.
Mr Matlala responded that the issues were raised with the Department and when they ended up writing this petition they had received no response from the Department at all. They had several meetings but they did not receive any communication from the Department. They only learnt about the removal of the building of the Health Care Centre in 2018/19 to 2019/20, in the district municipality IDP document without any communication to them, and currently the financial year is ending next month.
On the second question Mr Matlala said as indicated in the petition there was a budget to upgrade Dichoeung Clinic, but officials from the LPDOH deliberately diverted that money to build a clinic in another village called Madibong. However since 2008, that budget was meant for the Dichoeung Clinic.
Ms Mmola said the MEC of Heath in Limpopo was supposed to be in this meeting because he/she is the better person to come and explain why they took money which was meant for Dichoeung Clinic and built another clinic in Madibong village and named it Dicheoung Clinic. Because the MEC is not present they cannot get answers they want as a Committee.
The Chairperson said that they were not going to probe the petitioner further on this matter because it is the LPDOH who needs to answer. This Committee will take the matter further with the provincial department.
Mr K Motsamai (EFF, Gauteng) noted that there is lack of staff in the old Dichoeung Clinic. He asked what the complement of staff is in the old Dichoeung Clinic.
Mr S Zandamelani (EFF, Mpumalanga) asked what the distance was between the old Dichoeung Clinic and the new Madibong Clinic; and whether these two clinics were in the same ward.
Mr Matlala said the two clinics were five kilometers from each other in terms of distance. And on the issue of the ward, they are not in the same Ward; Madibong is in Ward 19 and Dichoeung in Ward 18.
Mr Matlala said on the question of staff, the old Dichoeung Clinic has three professional nurses, which made the clinic impossible to operate on weekends and on a 24hr basis.
The Chairperson said they will hand over to the NDOH to make its presentation because between the Committee and the LPDOH, the LPDOH had a better understanding of what is happening with regard to this petition.
Mr Ramphelane Morewane, Chief Director: National Department of Health (NDOH), thanked the Chairperson and the Committee for inviting them to the meeting. He said his Department had received a complaint about the state of the Dichoeung Clinic from the secretary of Dichoeung Clinic Committee in Dichoeung village. The NDOH delegation led by the Chief Director District Health Services and Director- Ideal Clinic held a meeting with the Clinic Committee in in March 2016. The purpose of the meeting was to find a resolution to the problem with all stakeholders. The Minister wrote a letter to the clinic following the meeting to say that they should work with the province to address the problem. The clinic committee rejected the Minister’s proposal because of a loss of confidence in the leadership of the Provincial Department of Health (PDOH) on the matter.
In terms of the background there was a need to upgrade Dichoeung clinic due to the depreciating infrastructure (1977-2007). The upgrading of Dichoeung clinic was initiated during the 2006/2007 financial year. This was after the community meeting took a decision on the site of the clinic on 07/03/2007. The agreement from the same meeting was that Kgoshi Kgoloko of Madibong would provide a site for construction of the new clinic. According to the minutes of the same meeting, this was a unanimous decision. This dispels the allegation that the ward councillors who were aligned to Madibong village (a neighbouring village) unilaterally identified the land on the Madibong side for the construction of the clinic. The naming of the clinic was based on the understanding that the new clinic was a replacement of the Dichoeung Clinic, which was old and dilapidated. The construction of the new clinic meant that the resources that should be received by the old Dichoeung clinic are diverted to the new facility for a more efficient use of resources.
The objection of Madibong clinic construction was raised during the implementation phase of the clinic (while the construction was happening). The community of Dichoeung felt betrayed and cheated by the Councillors who consented to the building of the clinic in Madibong side. They also felt that the new clinic should not be called Dichoeung because it is in Madibong.
Thus the following was suggested:
- The old clinic should not be closed as it continued to be operational;
- As a temporary solution, the LPDOH commenced with renovations of the old clinic;
- Identification of an appropriate site on the Dichoeung side to build a clinic; and
- Expression of dissatisfaction (poor project monitoring).
Mr Morewane said that in terms of the general principles of building a health care clinic the distance between the old and new clinic is approximately 4 km, which is within the national norm. The Department does not build health facilities per traditional leadership but for the catchment population. The new Dichoeung/Madibong clinic was able to provide equity of access and service coverage to the catchment population. Madibong and Dichoeung communities are historically the same people under different traditional leadership titles who have historically shared the social resources such as schools and the old Dichoeung clinic. If the proposed clinic is to be built, it would not necessarily be in Dichoeung, because it would have to be central to serve all the areas from Magnet Heights and Jane Furse areas.
With regard to the engagement between the NDOH and the clinic committee Mr Morewane said that the NDOH was involved after the clinic committee had referred the matter to the Minister for intervention. Several meetings were held with the community, Sekhukhune District and the provincial office in order to find a solution; and the following was proposed and agreed upon during one of the meetings:
- The district office will make a motivation to the province to include the Community Health Centre (CHC) for the people of the areas including Dichoeung. This was to be included in the 2018/19 financial year;
- Makhuduthamaga Local Municipality to include the new facility in the IDP for 2017/18 to 2018/19; and
- The district to proceed with the refurbishment of the old clinic so that the staff can operate in habitable conditions while a permanent solution is being sought.
The Clinic Committee did not agree with the general principles. The Clinic Committee further rejected the Minister’s proposal that they engage the Limpopo Provincial Department of Health directly citing loss of confidence. They indicated that the Department’s continued use of the name of their clinic to benefit the “wrong” clinic is tantamount to fraud; and they demanded that the old clinic should stop using the name Dichoeung, as it is in Madibong. The clinic had produced evidence that the province allocated a budget to build the clinic which made them determined to build that clinic.
Mr Morewane said the proposed solutions at the time included the following:
- The old clinic should have ceased to operate when the new disputed clinic was opened in order to avoid duplication;
- A CHC was proposed which will support the neighbouring clinics as a referral service point for the following villages: Madibong, Dichoeung, Moretsele, Moraba, Vergelegen, Tsehlwaneng and Maphopha etcetera;
- The community was requested to identify a site which is at least three (3) hectors in size which will be enough to accommodate the CHC; and
- The province was ready to conduct the survey of the identified site to see if it is suitable.
- The establishment of a steering committee comprising of:
- The Local Area Manager.
- The clinic manager and clinic committee member: Mr E Matlala.
- Terms of Reference
- Monitor the renovation of the old clinic.
- To meet once per week; and the District Office was planned to meet with the steering committee once a month to receive reports on the progress made.
- NDOH to share the decisions of the meeting with Limpopo Province Department of Health.
Mr Morewane said the proposed way forward was as follows:
- The community of Dichoeung was to accept that the new clinic (Madibong) was meant to serve all people that were previously served by old Dichoeung clinic;
- The search for the new site for the construction of the CHC which may have to be central to the villages to be served to continue;
- The province to consider building the CHC for the identified villages around Jane Furse and Magnet Heights when the budget for both construction and running costs is available and in line with the prioritisation of the infrastructural needs; and
- The clinic committee to work together with the provincial department of health to address the possible construction of the CHC in the identified area.
In conclusion Mr Morewane said that they recommended that:
- The Select Committee on Petitions and Undertakings (NCOP) note the report on the following:
- The Department is committed to building health facilities to improve access to service delivery;
- The health facilities must be central to all communities within the catchment area; and
- The construction of the health facilities must be based on the ability of the province to operate such facilities with limited resources.
Community participation in service planning and delivery is key in integrated development planning.
The Chairperson invited Members of the Committee to ask questions of clarity in terms of the presentation because the Committee in its own meetings will discuss the contents of the petition going forward.
Ms Mmola said that the NDOH presentation is short on coming up with other issues that have been discussed in its engagement with the petitioners, and the presenter is not sure on some matters and did not want to commit himself to certain issues that were discussed previously with the provincial department. This means that the provincial department did not discuss everything with the national department because the presenter did not want to commit himself, and they did not discuss everything which is confusing Members of the Committee.
Therefore, as she already stated above the MEC of Health in Limpopo is the one who is supposed to be here so that he/she could explain to the Committee how it is that they have built a clinic in Madibong village with the budget that was meant for Dichoeung Clinic and still call the new clinic the same name. So, the province must come and explain exactly what happened in its discussions with the petitioners.
The Chairperson said the Official from the province has just arrived and she is late because she was supposed to be in this meeting at 09:00hrs but she just arrived at 09:45hrs, which is uncalled for and disrespectful to this Committee.
Ms Shaikh said that she wanted to add to what Honorable Mmola has stated because in the NDOH presentation there is a use of the word “assumptions”. But as a Committee they were more interested in facts rather than assumptions in terms of the petition because once one goes to the area of assumptions they will stir a lot of emotions, and this should be avoided.
She asked how many times the NDOH had interacted with the provincial department regarding this petition, and what the actual agreements and disagreements were so that it could come out clearly what the facts are rather than any assumptions that were there.
Mr Zandamela said that the presentation from the NDOH is very disappointing because the Department received the petition in 2016, and they are now in 2020 so one could see that there is a serious problem when it came to the Health Department taking this matter seriously.
He asked whether it is the same budget or another budget that was used to build the Madibong Clinic. ‘Why should the issue of identifying a site take so long’? They could use the municipal IDPs so that communities could decide for themselves where they want their clinic to be situated.
Mr Zandamela said that the presentation is all over the place and he is confused about whether the issue is about the naming of the clinic, about budget constraints, or the old clinic versus the new clinic, it is confusing. The Department needs to be straight and clear in terms of what it has done regarding this petition so that they could be able to assist the Department as a Committee in resolving this issue of the clinic.
The Chairperson said that she wanted to remind both the National Department and the Provincial Department that when they talk service delivery or development to their communities they cannot make communities spectators in their own development, which is very clear. What is not coming out is very clear is the interaction between the Department and the community. But what is strongly coming out in the presentation is the issue of traditional leadership, where it is made clear that the Department is not building a clinic for certain traditional leaders because it is going there fixated and not wanting to listen to what the community leaders are saying. This is a serious problem that can create serious problems for that community. Therefore, they should know that they cannot do development without meaningful community participation. The Department needs to go through its plans with the community and not just involve the community at the tail end of development process.
Mr Morewane said that he may have over stated that there were assumptions. The point he really made was that he is not in a better position to deal with the issue of SOPA (State of the Province Address) pronouncing differently around what they have confirmed, and he would like to apologise if that is construed as assuming everything.
Mr Morewane said they had meetings with the petitioners representing the community on a number of occasions and had explained to them at the beginning what the situation was regarding building the clinic. There were areas where they did not agree with the Department, but obviously they had learnt from those sessions. He had already said, in the meeting of March 2007 a decision was taken that the clinic will be built in Madibong. The reason he had an assumption was because he was not present at that meeting but had looked at the records of that meeting. But of course this point was not what the petitioners raised when they met with them; they raised a matter about the counsellors cajoling them about the building of the clinic in Madibong.
On allowing communities to participate in their own development, Mr Morewane said it is a matter they take seriously as a Department because they continuously engage with the communities on various matters around service delivery needs. They even engage on matters that are on mayoral committees finding their way to the IDPs.
Mr Morewane said in terms of their communication with the province, even on the date of the decision for the CHC, that proposal was made by the representative of the LPDOH. They simply embraced it because again they did not want to be seen as carrying around solutions to the provincial problems. They only went to the province to provide guidance where necessary. But their colleagues from the provincial department are the ones who mooted that idea. They even agreed that the identification of a site would be led by the provincial team because they knew the dynamics and what needs to be done. The kind of expertise for that kind of work was with them, and that was the decision of the meeting. All the time they were meeting and in agreement with the Provincial Department of Health and in the presence of the district management team, which was taking the lead and not providing guidance.
Mr Marewane said that on the question of the name of the clinic; when the problem of the joint names for the Madibong clinic was raised they immediately wrote and indicated to the district and his colleagues in the province that it is a matter that must come to an end. The response they got from the province was that the matter of the name has been corrected. But the details of that problem of the joint name are with the province and since the province is here maybe clarity can be sought in this regard.
Dr M Dombo, Deputy Director-General: Health Care Services: LPDOH, thanked the Committee for the opportunity. She apologised to the Committee for coming late because her flight was delayed by an hour. In responding to the issues that were raised by the Committee, the issue of the Dichoeung Clinic status was reviewed in 2007 and during that time a budget was identified. During that time it was identified that the clinic required an upgrade.
Ms Shaikh interjected and said that that they should be provided with the document that the Official is talking to.
The Chairperson asked Dr Dombo to provide Members with the document being spoken about.
Dr Dombo responded that they had made a joint document with the NDOH which was already presented to the Committee by Mr Morewane.
The Chairperson said that their understanding is that they had invited them as separate spheres of government and they needed a separate presentation from the province because they had received the presentation from the NDOH in writing and it does not say anything about the province.
Ms Mmola said that it cannot be accepted that the province does not have a presentation of its own because they had already received a written presentation from the NDOH. Also, they cannot accept the apology of Dr Dombo for coming late in this meeting because she knew that the meeting would start at 09:00hrs. Instead she is talking about flight delays. She should have slept over in Cape Town a day before this meeting. Mr T Dodovu (ANC, North West) said that now he understands why there is so much delay with the building of the clinic. Firstly, the official from the provincial department came late and she did not even know what the national department has presented. The construction of a clinic is a direct competence of the province not national. The provincial department must understand that this exercise they were undertaking is very costly to assemble people in the way they had assembled them to come Parliament. They were not there to play because their people are yearning for a very important basic service of a health facility. The Department needs to take this matter seriously because it affects the lives of their people.
Ms Visser said that she can see that there is ignorance from the side of the Department in terms of public participation. The community has a basic human demand to be met since 2007, and now it is 2020 and nothing has been done about it because of names where the clinic has to be built. They cannot continue like this because the community will revolt and start destructive behavior. This can be done in terms of service delivery protests which will bring in the police with rubber bullets. This should be avoided. Therefore, they need to communicate with the communities and the LPDOH should go back and give feedback to the community.
Mr Zandamela said the Chairperson should provide a way forward on this matter because the provincial department has already indicated that this is a joint presentation with the NDOH, and there is nothing different that is going to be presented by the province.
The Chairperson said that firstly Dr Dombo has disrespected this Committee by coming late. Secondly, she has failed to prepare for this meeting by not providing the Committee with the relevant document from the province regarding this matter. They were not even expecting her to come to this meeting, but were expecting her political head to come and account to this Committee.
The Chairperson said that in terms of the way forward regarding this petition the Committee is forced to go to Limpopo. Firstly, they must go and inspect the old clinic and also visit the new clinic. Secondly, the Committee will convene a community meeting in that area and satisfy themselves about whether a community meeting was held previously in terms of consulting about building the new clinic. And further what the decision was in that meeting and also backing up the information they will be receiving.
She said that they were pleading with the Department to give the Committee the minutes of that meeting and the credentials of the people who attended the meeting. The Committee would also want to meet with all the members of the clinic committee of Dichoeung so that a Committee they collect all the necessary information so as to be able to give the relevant guidance to the Department. The Committee will communicate with all the stakeholders about when that visit will take place and will also make sure that the MEC of Health in Limpopo is present in that meeting. This will be a fact finding mission that will be directed at the province.
The Chairperson thanked Members and the representatives of the Department for their inputs and availability.
The meeting was adjourned.
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