Briefing by Department of Health and Wellness on progress made on infrastructure project at Hornlee Clinic in Knysna

Meeting report

Briefing by  Department of Health and Wellness on progress made on infrastructure project at Hornlee Clinic in Knysna

Dr Laura Angeletti-du Toit, Chief Director, Infrastructure and Technical Management, Western Cape Department of Health (WCDH), told the Committee that the current Hornlee Clinic was established in 1986 and previously functioned as a municipally run clinic with limited services. The clinic was too small to deal with the patient load and was overcrowded with poor patient flow. The full package of services could not be provided, and the facility could not be altered or extended.

Discussions with the Municipality started in 2014 on building a new clinic on the site of a taxi rank that was not being used by taxis. The Knysna Town Council was amenable and informed the Department in July 2021 that it should take occupation of the site while a lease agreement with the Department of Infrastructure and rezoning of the site were being finalised.

Implementation of the project was delayed by the need to deal with new priorities rising from the COVID-19 pandemic. The project brief was completed in July 2022 and construction work would start in July 2024.  

(See the attached slide presentation for details.)

Discussion

The Chairperson noted that he accompanied the provincial Minister of Health when she visited the existing clinic. It was observed to be overcrowded and cramped. Talks with community leaders showed that the new clinic was needed urgently. However, procedures had to be followed and should not be rushed.

Ms A Bans (ANC) noted that the request for replacement of the clinic dated from July 2019 and the project brief was completed in July 2022. She asked when the initial work on the site started or whether any work had been done. Had the fencing of the site been completed? Referring to the example of the old GF Jooste Hospital site, she said it amounted to fruitless and wasteful expenditure if building began long after fencing and security had been provided. When would the patients of Hornlee start walking into their new clinic? Had the work started or was the only payment so far for security? 

Mr D Plato (DA) stated that the whole project was a work in progress with time frames. They indicated that construction would commence in July 2024. This was tight enough and he hoped the Department and contractor would stick to it. The new clinic was long overdue. He noted that the municipality had given permission to demolish the taxi rank. He was glad that the municipality was on board. It showed cooperation between entities of state, which was very important. Challenges would always exist, but how they were dealt with was important. The challenges would be dealt with within the current time frames and were also a work in progress.

Ms N Bakubaku-Vos (ANC), referring to slide eight, asked about the estimated cost of the lease agreement. Referring to slide 11, what exactly was a management contractor and was it normal practice for companies to do jobs for the government upon request? Where did the request come from and what was the total value of work given to Grinaker? Referring to slide 15, where was the process now? Were there any delays and if so, what measures were taken to avoid further delays? The Committee did not want this project to take forever. Could the Department expand on the challenges referred to on slide 17? Were there any subcontractors that had not been paid for work done and if so, how had the Department intervened? Referring to slide 19, what other benefits were there for the community besides providing employment opportunities for locals? How many local companies would benefit from these contracts?

Ms R Windvogel (ANC), referring to slide five, asked about the total value of the project and the breakdown per year. Had the lease agreement been signed now? If not, when would it be signed? Regarding the 2023/24 2024 Western Cape Government Health and Wellness user asset management plan (UAMP), which other facilities were in the UAMP and were Klipfontein Regional Hospital and Vanguard Day Hospital part of it? Recently, she visited Vanguard Day Hospital and saw firsthand that the situation was bad.

Responses

Dr Angeletti-du Toit said the cost of security had to be balanced against the risk of invasion. Following the painful experience at Bloekombos, there was a decision to preserve the site by spending money on fencing and security rather than risking illegal invasion.

The cost of the facility was estimated to be between R25 million and R35 million. This project was similar to other rural clinics being developed. The cash flow was linked to the planning, with most of the money being spent on construction between July 2024 and April 2025. The door would open in April 2025 if construction ended on time. The construction period was tight at ten months, but it might be possible to shorten the design period with cooperation from all stakeholders.

Ms Angeletti said using a management contractor was a procurement methodology endorsed by the Construction Industry Development Board. Four methodologies were allowed in construction: design by employer, design and build, develop and construct, and management contractor. Design by the employer involved completing the design before going out to tender for construction. Design and build involved going out to tender for both design and construction. Develop and construct involves completing concept design and design development before going out to tender for development and construction.

Ms Angeletti said the Department used five management contractors appointed to projects on a rotational basis. Payment was linked to the stage of development and deliverables. No money had been paid to Grinaker thus far. The design of Klipfontein Hospital was underway with some ideas from consultants already seen. The upgrading of Vanguard was being revisited. The UAMP was updated every year with priorities and progress on projects for a timeframe of five to 15 years.

Subcontractor risk was a general risk that must be mitigated. Job creation was assessed through a process that showed the impact of service providers and the categories of jobs that could be created.

Ms Milne van Leeuwen, Director: Infrastructure Planning, said the lease agreement was a 99-year notarial lease of R100 a  month or year. Dates have been provided to the Department Of Infrastructure and the lease should be finalised within the next month.

Further discussion

Ms Bans said that representatives of the Gugulethu community had attended a Committee meeting the previous week and reported a similar situation in Hornlee. She asked for the Department’s view on this situation. The Minister had reported the previous week that site visits had been done. When would the new clinic be opened?

Ms Windvogel expressed concern about a perceived lack of care for black and coloured communities in identifying clinics and hospitals for upgrades, expansions or renovations. Clinics and hospitals in black and coloured communities were often the last to receive attention. She also inquired about the Department's security measures. Was the Department paying for security to look after land or other assets, and if so, how much did it cost?

The Chairperson said the presentation had referred to using an existing clinic design for rural areas. However, some areas, such as George, were no longer considered rural in terms of numbers. He hoped this would be considered and that there would be a space on the property where people could shelter from rain. One common thread that ran through all the facilities visited so far, particularly Hornlee, was that when the elements were against them, there was very little space for people to be protected. In broad terms, using existing designs for clinics was appreciated as it was a huge cost saver.

Responses

Dr Angeletti-du Toit said a programme, called the waiting and sheltering programme, was started the previous year. A series of facilities in dire need of sheltered outside waiting areas were identified, and a standard design was being finalised. The plan was to have a similar methodology and to ask one of the management contractors to implement it. Considerations included ease of building and standardisation of shelters. The list of facilities could be shared if required.

Information on the cost of security would be provided.

Regarding the location of projects, the Department looked at indicators such as demand and the condition of facilities. Equity among districts was also considered. Prioritisation of projects was discussed with governance structures and agreement was reached on different types of infrastructure such as primary health care facilities, psychiatric units and emergency centres. Mental health was one of the priorities with three psychiatric units in construction. Emergency centres were also being developed and expanded with upcoming projects in Robertson and Groote Schuur. Priorities were linked to functionality and departmental priorities.

A site in Gugulethu was in the process of being transferred from the City of Cape Town to the provincial government. The plan was to build a new community day centre (CDC) on this site and then transfer the entire community health centre to the new facility. Almost everything on the current site would be demolished. This project was one of the top priorities. The procurement and design processes were being expedited. 

Ms van Leeuwen said there had been a meeting with the community approximately two months ago. The planned completion date for construction was November 2028, but efforts were being made to improve this time frame. A maintenance project was also underway to improve ventilation in the facilities, with a planned completion date of 2026. As mentioned earlier in the presentation, the intention was to replicate one of the clinics when designing Hornlee. Similarly, for Gugulethu, a recently completed or designed CDC would be examined to determine which components could be replicated to expedite the design process.

There was a commitment to regularly provide feedback to the community so that they were part of the design process and informed about the progress of these projects. The first engagement would be to present the layout to the clinic committee and council once the consultants, architects, and engineers had drawn it up. Community meetings would occur before construction commenced to share information about local labour opportunities and alert communities to the construction. This allowed local businesses to prepare themselves to tender for work. Expectations were set regarding the number of local labour opportunities and their duration. The project steering committee was also important as it involved community members who could provide feedback on the progress of the project. This mechanism has been found to be effective in mitigating risks during construction.

Further discussion

Ms Bans asked what had caused the delay in the Salt River Mortuary project.

Ms Windvogel sought clarity on the relocation of the Gugulethu health centre and whether it would be rebuilt within the community. She said the community might suffer the same fate as others where a health centre was demolished and not rebuilt. She also raised concerns about job creation within the community. During projects, not only in health but also in education, the use of community work programmes (CWPs) or the Expanded Public Works Programmes (EPWP) resulted in people being paid below the minimum wage for the building industry. Skilled workers were brought in from outside the community or town, causing pain for the community.

Responses

Dr Angeletti-du Toit said the issue of the forensic pathology institute at Observatory, which was replacing the Salt River Mortuary, was the most complex that she had been involved with in her 40 years in healthcare. The building was complex due to its state-of-the-art laboratories and extremely complicated standards requirements. After construction was completed, it was discovered that the laboratories could not meet the standards for specific tests. This project had been a learning curve and efforts are being made to improve the quality of the building as it progressed. The contractor who built the institute was currently on site fixing everything and was expected to finish within the next six months.

Most of the deceased had already been moved from Salt River to the new institute. However, the laboratories were not yet 100 percent completed. The commissioning time had been long, but it was a more complex building than a hospital. The National Department of Public Works owned the site at Salt River and would be handed back to them by the Department of Infrastructure. It was unclear what would happen to the site after it was returned.

Regarding job creation and the EPWP, the Department had a small grant of R2.5 million that it used to appoint people that were trained to do small maintenance. It had been very successful over the past 15 years and some of the people had gone ahead to qualify as artisans.

Committee Resolutions & Recommendations

Ms Bans said that the Hornlee project was expected to be completed by April 2025 and the Salt River one by November 2028, after the term of the current committee. She suggested they conduct an oversight visit to Salt River in late October to allow some space to keep track of progress. She also asked the Department to provide a report on the value of all priority projects it undertook.

Ms Windvogel suggested that the Committee get a presentation on progress of all the infrastructure projects run by the Department in the whole of the Western Cape. She requested that the Committee visit the Vanguard Community Health Center.

The meeting was adjourned.