21 August 2020 - NW1818
Chirwa, Ms NN to ask the Minister of Health
Whether the support team led by Dr SibongileZungu, including Professor Ian Sanne, Theo Lighthelm, Albert Jansen, Dr Dorman Chimhamhiwa and Wendy Ovens that was deployed by Minister ZweliMkhize in the debilitated Eastern Cape Department of Health has submitted any report with recommendations regarding what needs to be done in the specified province; if not, what is the position in this regard, if so, (a) what were the recommendations and (b) how far has each recommendation been implemented?
The intervention team has submitted a report to the Eastern Cape Department of Health, the Office of the Premier, and the Office of the Minister of Health.
The report submitted covered the analysis and the state of the COVID-19 response in the Eastern Cape for the period, 29th June 2020 until 10th July 2020. The report recommended nine areas of intervention. The recommendation made by the Strategy Team is following the key strategic areas as outlined by the WHO-COVID-19 response guideline as tailored to the provincial needs.
(a) The recommended interventions
1.1 Coordination between Tertiary, Regional and District hospitals is inadequate and should be addressed through the revised command and control structure.
1.2 Given the busy schedule of the SG, it would benefit the Province to have a Project Manager for COVID19 with the necessary authority to fast track actions.
1.3 While the metros have mobilised reasonable infrastructure to meet the surge, the Eastern Cape Department of Health (the Department) needs to give attention to the scaling-up of service delivery requirements such as the adequate provision of oxygen, equipment, human resources, and medicines necessary for the management of the Pandemic.
1.4 Certain hospitals are currently overwhelmed (Doran Nginza in NMB in particular) by the patient demand, and lack of infrastructure, equipment and human resources to meet the clinical care demand which the Department needs to address.
1.5 Labour relations is a matter that requires a dedicated action plan to normalise service delivery.
1.6 Historic arrangements for drainage areas, resource allocation, and referral routing are not addressing the significant surge in patient numbers, particularly in underserved, vulnerable populations.
1.7 Emergency Medical Services and patient transport services require intervention to ensure continued function.
1.8 Within the Province, the oxygen separation plants are located in the Nelson Mandela Bay Metro. The distribution of the oxygen is, therefore, a challenge for areas furthest from the Metro.
1.9 Implementation of a comprehensive data system to capture the parameters of the COVID-19 response.
(b) How far each of the recommendations has been implemented
1. Coordination between Tertiary, Regional and District hospitals is inadequate and should be addressed through the revised command and control structure.
The Intervention Team assisted the Department to establish its Command and Control structure which was adjusted from the Department’s strategic documents.
The structure is divided into three layers, Provincial, district and facility specific. Each structure has adopted an incident management approach (WHO-COVID-19 Guidance) with daily command and control meetings covering the following areas:
- Epidemiology and Surveillance
- Community engagement for prevention, contact tracing and testing
- Laboratory support and result reporting
- Treatment and Care including facility surge capacity
- Infrastructure and equipment
- Logistic support - pharmacy, consumables and personal protective equipment
- Emergency Services
- Psycho-social support to health workers
- Port Health
The strategic area of Port Health is not given a daily focus as Port Health is a national competence. The PMU is vigilant around Port Health issues and receives reports relevant to the Province from the National Department of Health.
2. Given the busy schedule of the SG, it would benefit the Province to have a Project Manager for COVID-19 with the necessary authority to fast track actions.
The Premier of the Province Hon. Mr. Oscar Mabuyane announced the establishment of the Project Management Unit for a comprehensive response to COVID-19. The Project Management Unit(PMU) has established the following structure (Fig. 1 below).
Dr Zungu leads the PMU. She works with Dr Monde Tom, a financial management expert with vast experience in both the public and private sector, leads the Business Continuity Workstream and Mr LauwrenceVanZuydam an experienced HR executive seconded from the Office of the Premier.
The project leader is responsible for directing all COVID-19 activities and for fasting track actions. The PMU has been integrated into the overall Eastern Cape Department of Health’s Covid-19 response and supports the HOD as the accounting officer.
The structure of the PMU and the related workstreams is depicted below.
4. Certain hospitals are currently overwhelmed (Doran Nginza in NMB in particular) by the patient demand, and lack of infrastructure, equipment and human resources to meet the clinical care demand which the Department needs to address.
This recommendation is specific to DorahNginza and Livingstone hospitals as there had been persistent negative media reports about the two facilities.
Dora Nginza Hospital
The Department resolved the congestion of the maternity wards at DorahNginza by strengthening the peripheral clinics to operate their midwife services. They have also addressed the shortage of staff by fast-tracking the recruitment of doctors and nurses.
Upgrade of Dora Nginza Hospital- 100-bed wing
The Department upgraded a dilapidated wing of the hospital to provide a 100-bed wing to support the COVID19 peak. The project was part of the Province’s “Accelerated Construction Program” which meant that a project that would typically take four months, the constructors completed in two months. The Department handed over the site to DorahNginza Hospital on the 6th July 2020.
The National Oxygen Team undertook an audit of the whole oxygen reticulation system of the Dora Nginza hospital. It found that the hospital has four Oxygen Manifolds with only one partially functional. Repairs to the system commenced on the 28th July. The local car manufacturing company has committed to the replacement of two manifolds, and the Department has ordered a further one. The full functionality of all the manifolds will ensure a continuous supply of oxygen at the correct pressure and volume.
The Department undertook a project to upgrade the basement to provide an additional 68 Beds with Oxygen. The initiative is also part of the “Accelerated Construction Program”.
The Department appointed an Acting CEO for the Livingstone hospital on 22nd July. Also, they have advertised the post of Nursing Service Manager and CEO. The processes will be fast-tracked.
The hospital management set-up a short-term 6-month cleaning contract. The intention is to ensure that the staff at Livingstone hospital are reoriented into a deep cleaning routine and protocols. The washing machine has been repaired, resulting in improvement with the laundry services.
3. While the metros have mobilised reasonable infrastructure to meet the surge, the Eastern Cape Department of Health (the Department) needs to give attention to the scaling-up of service delivery requirements such as the adequate provision of oxygen, equipment, human resources, and medicines necessary for the management of the Pandemic.
6. Historic arrangements for drainage areas, resource allocation, and referral routing are not addressing the significant surge in patient numbers, particularly in underserved, vulnerable populations.
7. Emergency Medical Services and patient transport services require intervention to ensure continued function.
8. Within the Province, the oxygen separation plants are located in the Nelson Mandela Bay Metro. The distribution of the oxygen is, therefore, a challenge for areas furthest from the Metro.
We have addressed the recommendations 3, 6, 7, and 8 above through adoption of a service delivery model that rearranges the structure and resource distribution within the Eastern Cape health system to optimise service delivery.
Currently, the major urban areas contain all the critical care capacity, that is Nelson Mandela Bay and Buffalo City metros, Mthatha, and to a limited extent, Queenstown. The outer reaches of the western, central and eastern areas are more than three-hour drive time from existing critical care beds. In collaboration with the Provincial Department of Health, the PMU developed a Hub and Spoke approach to address the shortfalls. The purpose of the Hub and Spoke strategy is then to identify the hospital drainage (referral pathway) to existing and or expanded Critical Care capacity coupled with the estimated distance and travel times to reach a bed safely at the peak of the COVID19 Pandemic. The PMU has also determined the high-risk areas based on at least one of the following factors:
- Travel times between facilities
- Travel distance between facilities
- Quality of the road infrastructure
- Quality of hospital infrastructure between the referring hospital and the receiving hospitalCritical care bed saturation
The District team are in the process of confirming satellite hubs for the expanded distribution of COVID19 critical care beds to address the potential shortfall. The PMU will support the Province to optimise existing district hospitals based on minimal input but with a maximum return.
The Department of Health supported by the PMU has made the following progress:
Infrastructure: The following infrastructure projects are underway in the Province, to yield a significant increase in the general ward beds (n=2,022) and critical care beds (n=311). The addition of the infrastructure development from the baseline will address the NEC long-term projected peak demand for COVID-19 admission in the districts and Province. The Rev Dr Elizabeth MamisaChabula Hospital facility will receive an additional upgrade of the current Phase I priority three beds to include additional oxygen supply. The intervention will add 312 oxygen beds to meet the demand in the Nelson Mandela Bay Metro and surrounding districts.
Figure : Estimated General Ward Beds required to meet the demand for COVID-19, current and projects under construction.