Free State COVID-19 Update & Vaccine Plan
03 March 2021
The purpose of the virtual meeting was for the Committee to be briefed by the Free State’s Provincial Department of Health on its healthcare services in relation to the COVID-19 pandemic. The second item on the agenda was for Members to receive a briefing from the Free State Department of Health on its strategy for the COVID-19 vaccination rollout. The last item on the agenda was for the Committee to consider and adopt its outstanding minutes for its previous meetings.
The Free State Provincial Department of Health explained that it follows the principles for public health ensured that the tracing of all those who have been in contact with COVID-19 and the subsequent isolation of people who were infected. The Committee was ensured that the impact was less significant that it could have been. There is a chronic shortage in staff in its facilities, and the inclusion of communal care workers within the Free State Department has had a mitigating effect. The overall strategy of the Free State Department is evidence-driven, based on crucial data management, includes strategies and implementation and is supported by a well-rounded organisational structure. Budget cuts continue to impact the service delivery of the Department. It was also reported that the Department has shifted its priority towards using funds to upgrade and improve the existing facilities within the province to ensure that it can be used for future healthcare services.
It was reported that the Free State has a population of approximately 2.93 million people, and 67% (1.96 million people) have to be vaccinated to achieve herd immunity. More than 300 000 in the province are above the age of 60, and 40% of the province’s population live in rural areas without proper access to routine healthcare services. The province will follow a phased approach to vaccinations. During the first phase, all healthcare workers will be vaccinated as a priority given the limited doses of the vaccine that will be available. The first phase is scheduled to start in March 2021. During the second phase, all essential workers will be vaccinated together with people in congregate settings, the elderly above 60 years of age, and all people older than 18 that are living with comorbidities. The commencement of this phase is dependent on the delivery dates for the vaccine doses. The second phase will be characterised by a large number of vaccine doses available for use. During the third phase, all other people above the age of 18 will be vaccinated. The commencement of this phase is dependent on the delivery dates for the vaccine doses. The third phase will be characterised by a large number of vaccine doses available for use. The Free State’s Department of Health reported that there are 22 027 public healthcare workers and 36 993 private sector healthcare workers in need of vaccination within the province during the first phase.
The Committee welcomed the province’s plans to vaccinate all healthcare workers as the first line of defence against the virus. The Committee also advised the province to make sure that all those participating in the vaccination were made aware of the fact that they were participating in a trial process to test the effectiveness of the Johnson & Johnson COVID-19 vaccine. Johnson & Johnson had a clinical trial in South Africa where its safety and efficacy were established.
The Committee also welcomed the reports that the Free State was deriving value from the deployment of Cuban doctors, after the province was allocated 17 doctors from the team that is assisting the country in the battle against the COVID-19 pandemic. The Committee appreciated the report that some of the unresolved issues from previous engagements with the Free State’s Department of Health have since been attended to, such as emergency medical services.
The Chairperson convened the virtual meeting and welcomed Members, Committee support staff and the delegation from the Free State’s Provincial Department of Health (PDoH). The delegation from the PDoH consisted out of Ms Montseng Tsiu (the MEC for Health in the Free State), Dr David Motau (the Head of the PDoH), Dr Sammy Mokoena (Public Health Medicine Specialist), Mr Mzonakele Fikizolo (the Executive Manager for Resource Management and Support Services Branch), Ms Nkalimeng Makhoali (District Director for the Mangaung Metro), as well as Ms Grace London (Chief Director for District Health Services).
The purpose of the virtual meeting was for the Committee to be briefed by the Free State’s PDoH on its healthcare services in relation to the COVID-19 pandemic. The second item on the agenda was for Members to receive a briefing from the Free State’s PDoH on its strategy for the COVID-19 vaccination roll-out. The last item was for the Committee to consider and adopt its outstanding minutes for its previous meetings.
The Chairperson stated that as part of its oversight duties and to ensure effective provision of quality healthcare and application of policy, the Committee has invited all Provincial Health Departments to present their plans and strategies regarding combatting the COVID-19 pandemic. The Free State province was the last of the provinces to brief the Committee in this regard, hence the purpose of this meeting.
Opening remarks by the Free State MEC for Health
Ms Montseng Tsiu, MEC for Health in the Free State, stated that the COVID-19 pandemic has had many significant negative impacts on the country. However, the following of the principles for public health ensured that the tracing of all those who have been in contact with COVID-19 and the subsequent isolation of people who were infected, has ensured that the impact was less significant than it could have been. The Free State’s PDoH has a chronic shortage in staff in its facilities, and the inclusion of communal care workers within the PDoH has had a mitigating effect. The Free State’s PDoH experiences significant pressure on its facilities to increase the availability of beds within hospitals.
The Free State’s PDoH took a conscious decision to work on preparations for field hospitals. However, the priority is now to use funds to upgrade and improve the existing facilities within the province to ensure that it can be used for future healthcare services. Facilities have been identified that need upgrades in its infrastructure and an increase in its availability of beds. Extra staff members have been employed on a contractual basis. Budget cuts continue to have a significant impact on the Free State’s PDoH. She stated that daily surveillance reports are done by the provincial health team to ensure that the Free State’s PDoH has access to the collated date on the COVID-19 pandemic to adequately and timeously address any problems and gaps that can be identified in the province’s system of healthcare services.
Briefing by the Free State PDoH on its healthcare services relating to COVID-19
The first item on the agenda was for the Committee to be briefed by the Free State’s PDoH on its healthcare services in relation to the COVID-19 pandemic. Dr David Motau (the Head of the PDoH) presented the briefing to the Members. He stated that the purpose of the briefing was to inform the Committee on how the province is dealing with the aftermath of pandemic and the way forward.
Overview of the health situation in the Free State
The Free State’s PDoH has relied heavily on the National Department of Health and its established structures since the start of the pandemic. The first confirmed case of COVID-19 in the Free State province was reported on 16 March 2020. Subsequently, the Free State’s PDoH established a Command Centre to focus on providing overall strategic directives to the Head of the Free State’s PDoH. With the aid of several partners, the Command Centre provides technical support and assistance across the various areas of the healthcare system to collectively strengthen it and to ensure that appropriate measures are put into place. Daily provincial surveillance reports are compiled to ensure that the people of South Africa are updated with the most recent information relating to the COVID-19 pandemic.
Dr Motau stated that the Free State’s PDoH followed a district-based response to the pandemic. Based on the lessons learnt from the first wave of infections, its response was decentralised. The Provincial Command Centre remains responsible for overseeing effective and efficient responses to the pandemic. The District Command Centre is responsible for the coordination of sub-district surveillance and responses. The Sub-District Command Centre is responsible for daily response activities. The success of the response by the Free State’s PDoH to the COVID-19 pandemic is based on case investigation (including testing and tracing), contact tracing (tracking of close contacts for cases), and the monitoring of close contacts and cases to refer people to testing or admission to hospitals.
The Free State’s PDoH developed an organogram for case management teams to be established. The overall strategy of the Free State’s PDoH is evidence-driven, based on crucial data management, includes strategies and implementation, and supported by a well-rounded organisational structure.
Challenges faced in the COVID-19 pandemic
The Free State’s PDoH reported challenges regarding human resources, information management, and poor compliance to regulations, service delivery and case management.
Regarding human resources, challenges were reported relating to COVID-19 fatigue resulting from the first wave of infections lasting longer than other provinces, giving only one month of low caseloads, which were exacerbated by admissions and deaths of colleagues and family members. In addition, there was poor capacity for the response teams, leading to a backlog in cases that need to be investigated, and traced; there were reports of poor skills for the clinical management of patients.
Regarding information management, the Free State PDoH reported that there is a lack of adequate integration of information systems because of constantly changing technologies and systems. In addition, poor compliance to the COVID-19 Regulations was reported.
Concerning service delivery, the Free State PDoH reported that the impact of the COVID-19 lockdown has affected its healthcare services and a reconfiguration of services was necessary to maintain adequate responses, which led to an increase in cases of COVID-19 and other diseases. This was exacerbated by delayed surgeries, increased waiting times, budget cuts, and delayed rollouts of infrastructure and poor performance on strategic programmes.
Regarding the system of case management, it was reported that there was an increase in admissions in rural and remote areas (including the need for oxygen), a need to review ICU admissions criteria, and increase capacity in public hospitals and facilities.
The impact of easing lockdown restrictions
The Free State PDoH stated that as lockdown is eased across the country (such as the return to schools, reopening of businesses and an increase in public transportation), it expected an increase in the number of COVID-19 cases recorded. Hospitals have minimised its non-emergent and non-urgent services prior to the national lockdown. This was done for the following reasons: to avoid large groups of vulnerable patients and facilities where potential exposure or transmission of COVID-19 can occur, avoiding unnecessary exposure that can result in the loss of critical staff, the reprioritising of healthcare workers to help with COVID-19 services, and the opening of the hospitals wards and ICU beds for COVID-19 related admissions. None of these factors will show a change as the severity of lockdown is eased.
It was reported that any change in lockdown measures has a four-week delay until the effect is implemented. For this reason, no changes in the facilities’ operational patterns occur for four weeks after a decrease in the severity of the lockdown. Lockdown changes must be implemented in a stepped approach and must be thought of as a continuum instead of an immediate implementation.
A particularly important factor in the decision to return to a greater capacity in the healthcare facilities needs to be the continued use of Personal Protective Equipment (PPE). An upscale in surgeries and procedures will mean that the use of PPEs will increase dramatically, and this issue needs to be addressed urgently. If services are up-scaled at healthcare facilities, then the ward beds set aside for the purposes of COVID-19 would have to be redirected back to its original purpose. This is also true for ICU beds, and ventilator facilities that will have to be redirected if surgery capacity is increased. This could be problematic if COVID-19 cases increase once again the province. Theatres that have been set aside for COVID-19 pandemic will have to be reassessed and confirmed as if the facilities are fully returning to capacity.
A provincial multi-disciplinary team is the backbone of effective public healthcare, and the Free State PDoH’s use of district-based surveillance responses provided protection and relief and spared the province in the second wave of infections. Inter-sectorial collaboration is pivotal for the effective and efficient response for an outbreak of this magnitude. The Free State’s PDoH is preparing for a resurgence (the third wave of COVID-19 cases) by focusing on districts that were less affected in the second wave, increasing admission capacity in ICU facilities in public hospitals, strengthening containment measures, and incorporating other healthcare services in the resurgence plan for the third wave of the COVID-19 pandemic.
Briefing by the Free State PDoH on its strategy for rolling out the COVID-19 vaccine
The second item on the agenda was for Members to receive a briefing from the Free State PDoH on its strategy for the COVID-19 vaccine rollout. Dr Motau (the Head of the PDoH) presented the briefing.
Introduction and background
The overall goals of the Free State’s PDoH is to ensure that it rolls out a safe, effective, and efficient vaccination programme that plays a central role in halting the transmission of COVID-19 to help bring the pandemic to an end, and to build on the public health response to COVID-19 through the efficient provision of safe and effective vaccines to the Free State to reduce the consequences of the pandemic.
The objectives include the development and implementation of a provincial plan based on the national implementation plan for vaccinations for COVID-19, to identify the target population, service points, the availability of vaccinators, transport and supplies, to ensure that healthcare workers register on the electronic vaccination system, the procurement of medical supplies and needles, to liaise with the National Department of Health regarding the distribution of vaccines, the monitoring of coverage, and liaising with stakeholders and the private health sector in South Africa. The Free State’s PDoH established a Vaccination Committee for the province to ensure that the project is handled with sufficient coordination. The Vaccine Task Team will have similar functions to the national teams and will be responsible for the fulfilment of the objectives outlined by the Free State’s PDoH. The province has decided to follow a decentralised district-based approach with District Directors appointed as project leaders supported by the primary healthcare managers of each district. The governance and vaccine coordination structure will be aligned to that of the province.
It was reported that the Free State has a population of approximately 2.93 million people, and 67% (1.96 million people) have to be vaccinated to achieve herd immunity. More than 300 000 people in the province are above the age of 60, and 40% of the province’s population live in rural areas without proper access to routine healthcare services. The province will follow a phased approach to vaccinations. During the first phase, all healthcare workers will be vaccinated as a priority, given the limited doses of the vaccine that will be available. The first phase is scheduled to start in March 2021. During the second phase, all essential workers will be vaccinated together with people in congregate settings, the elderly above 60 years of age, and all people older than 18 that are living with comorbidities. The commencement of this phase is dependent on the delivery dates for the vaccine doses. The second phase will be characterised by a large number of vaccine doses available for use. During the third phase, all other people above the age of 18 will be vaccinated. The commencement of this phase is dependent on the delivery dates for the vaccine doses. The third phase will be characterised by a large number of vaccine doses available for use.
Regarding the first phase in the vaccination programme, there are five categories of healthcare workers that delineate the prioritisation of healthcare workers. The first category of healthcare workers that will be prioritised is of those who conduct aerosol-generating procedures and the taking of COVID-19 specimens. The second category is those healthcare workers who are in direct contact with positive COVID-19 patients. The third category is those healthcare workers who are in contact with patients who are not known or suspected to have COVID-19. The fourth category is healthcare workers who are in limited contact with patients, and the last category relates to healthcare workers who are not in contact with patients. The Free State’s PDoH reported that there are 22 027 public healthcare workers and 36 993 private sector healthcare workers in need of vaccination within the province during the first phase. Healthcare workers employed in hospitals will be vaccinated at their workplace. Healthcare workers working in smaller healthcare facilities will be vaccinated at their workplace or a nearby hospital, while those healthcare workers not linked to a specific facility (such as emergency staff and independent practitioners) will be vaccinated at the nearest vaccination site.
Regarding the second phase in the vaccination programme, there are four categories of people that will be vaccinated or eligible for vaccination. This includes essential workers, such as teachers, police officers, miners, the military, security workers, retail workers, banking staff, border control, and essential staff from municipalities and the Department of Home Affairs. It also includes people in congregate settings, such as people in prisons and detention centres, people in shelters and care homes, and also essential staff from the sectors of education, tourism and hospitality industries. People older than 60 years are also eligible for this phase of the vaccination programme, as well as people older than 18 who are living with comorbidities.
For the start of the first phase, the Johnson and Johnson vaccines and consumables are supplied through a contract research organisation, which is also responsible for the storage thereof and the adherence to protocols during the clinical trials. The province’s central medical depot will distribute the vaccines to the collection sites, or direct deliveries will be used as an alternative. There are currently 31 collection sites in the province with the appropriate storage conditions as approved by the World Health Organisation (the WHO). An additional 75 collection sites are awaiting final qualification from the WHO. The vaccines will be stored according to the specifications of the manufacturers.
The Free State’s PDoH will follow the Electronic Vaccine Distribution System (the EVDS) as implemented by the National Department of Health. Stakeholders will be continuously briefed about the introduction of the vaccines and their responsibilities in the programme, and the Free State’s PDoH will continue to inform stakeholders regularly on the progress of the vaccination programme and disseminating national guidance. Training regarding the vaccination programme has commenced on 15 January 2021 in the form of pre-recorded video sessions with study materials, followed by interactive question-based sessions. In addition, it was reported that the Free State’s PDoH is implementing adequate communication with the community on various platforms and through use of government employees, frontline workers, and local influencers.
It was reported that the Free State’s PDoH will identify target populations that will be prioritised for access to vaccines during the second phase, estimate their numbers and identify the relevant geographic locations. The Free State’s PDoH identified potential COVID-19 vaccine delivery and outreach strategies leveraging both existing vaccination platforms and non-vaccination delivery approaches to best reach identified target groups. The identification of vaccination sites to ensure that these sites are registered on the online portal is paramount. It must be ensured that each vaccination site has a sufficient number of vaccinators. The protocols for infection prevention and control measures, including adequate PPEs, must be updated to minimise exposure risk during immunisation sessions. The Free State’s PDoH must develop and review the accreditations and readiness assessments for vaccination sites. Standard Operating Procedures must be developed for delivery through the private sector’s healthcare facilities.
Rollout plan for the vaccines
The vaccination teams comprises of queue marshals, COVID-19 screening teams, vaccinators, data capturers, supervisors, and observers over the vaccinated individuals. A checklist for equipment for each vaccination site has been compiled and will be adhered to.
During the first phase of the vaccine rollout, the first batch of vaccine doses involved the Universitas Academic Hospital (3 800 doses), and the Pelonomi Tertiary Hospital (3 080 doses), showing a 2:1 ratio between the public and private sector. As on 28 February 2021, a total of 4 800 people have been vaccinated. For the second batch of vaccine, doses will include an allocation of 3 227 doses to the private sector, and 1 693 doses to the public sector. The Bongani Regional Hospital, the Life Rosepark Hospital, and the Fezi Ngumbentombi District Hospital was already prepared as sites for the rollout of the COVID-19 vaccination programme, and site visits were conducted. The vaccines will be rolled out from 02 March 2021 onwards.
During the second phase of the vaccine rollout, the people eligible for vaccination during this phase will be accommodated on a variety of platforms that are dependent on the capacity to provide service delivery. Essential workers will be vaccinated at their workplaces if there are occupational health services available. Otherwise, the vaccination will be done either privately, through mobile outreach-based centres, or through the redirection of essential workers to hospitals or clinics for vaccination. People in congregate settings will be vaccinated through district-based campaign outreaches to the congregate areas to vaccinate the people involved. Alternatively, such people will be vaccinated through mobile outreach-based centres.
The Free State’s PDoH has put systems in place to roll out the vaccine programme as planned. The successful implementation of this plan will depend on a number of factors, which include the availability of adequate vaccines to cover the population of the Free State, an aggressive demand creation effort to counter vaccine-hesitancy, robust programs, and continued engagement and collaboration with stakeholders. The plans in place will be reviewed constantly to check if the Free State’s PDoH is still on track, especially in the implementation of the second and third phases. Lessons learned from the first phase of vaccine rollouts will assist in enrolling more facilities across the province of the Free State.
Ms A Gela (ANC) welcomed the presentation from the Free State’s PDoH. She welcomed the plan for the rollout of the vaccines and the approach adopted by the Free State’s PDoH. She applauded the MEC for good work and leading by example by being the first amongst the people who were vaccinated in the Free State. It is fortunate that there have been no serious side effects of the vaccinations. The challenges that have been brought on by the pandemic can be overcome. She asked how many of the Cuban health professionals that were deployed across the country were deployed in the Free State province. Is the Free State’s PDoH experiencing any value in having the Cuban doctors employed within the province? What support is given to the healthcare workers with COVID-19 fatigue? Has there been an additional budget requested from the National Treasury to address the lack of human resources in the Free State’s healthcare facilities? Such a budget would help in the procurement of additional equipment, such as emergency services vehicles, to cover the areas in the province. What emotional responses have been received from the people within the province given the high number of people that have been lost to the COVID-19 pandemic? What measures have the Free State’s PDoH put in place to address its poor performance in strategic programmes? She also asked for clarity on the relationships between the public and private hospitals within the province. What is the disposal plan for medical waste relating to the vaccination process?
Mr M Sokatsha (ANC) welcomed the province’s plans to vaccinate all healthcare workers as the first line of defence against the virus. He asked how the Free State’s PDoH is addressing the shortage of oxygen for patients who need it. He agreed that one of the key priorities in the response to the COVID-19 pandemic is making sure that the people within the province understand the issue and process of vaccination. He also commended the MEC and the Free State’s PDoH on making this a priority. How many healthcare workers have been trained in the province to administer vaccinations? He commended the Free State’s PDoH on its plans to effectively communicate with the community regarding the concerns regarding the vaccinations. How will the Free State’s PDoH train healthcare workers who have to serve as vaccinators? What has the Free State’s PDoH learned during the COVID-19 pandemic regarding the need for a National Health Insurance?
Ms H Ismail (DA) thanked the Free State’s PDoH for the presentations and the comprehensive briefing to the Committee. There have been complaints regarding the shortage of medication at clinics. She asked that the Committee be provided with a full report on the availability of medicines in the clinics and facilities within the Free State. There have also been reports of a lack of maintenance of facilities, where reports of a lack of water and electricity have been received. What is being done to address these issues?
The lack of security at healthcare facilities remains a concern and if it is not addressed, the lives of the staff and patients are put at risk. She asked for a report from the Free State’s PDoH regarding how it is addressing these security issues. An update to the Committee is also required regarding the vacant posts within the Free State’s PDoH. How much was the tender for ambulance contractors and who has been awarded the tender? It was stated that some healthcare workers are hesitant. Is this because the vaccination process is still a clinical trial and not a completed vaccine? Who will be liable if there are any serious side effects to the vaccines, given the indemnity clauses in the contracts signed with the vaccine manufacturers? How has the Free State’s PDoH improved its emergency transport services in light of COVID-19 and normal healthcare services? What is the status quo of the intern doctors in the province? A breakdown of all doctors completing their community service within the province is needed. How many of these doctors are incorporated to address the shortage of staff in the facilities of the Free State’s PDoH? How has the selection of vaccination sites impacted the service delivery of the healthcare facilities within the province? How much have been incurred in the process of transporting healthcare workers from their places of work to the vaccination sites? Who is responsible for compiling data in relation to the Johnson&Johnson vaccines and submitting it?
Ms N Chirwa (EFF) asked what measures the Free State’s PDoH has put in place in response to minimise and prevent a significant increase in infections during the predicted third and fourth waves. She advised the province to make sure that all those participating in the vaccination were made aware of the fact that they were participating in a trial process to test the effectiveness of the Johnson & Johnson COVID-19 vaccine. Johnson & Johnson had a clinical trial in South Africa where its safety and efficacy were established. She stated that the vaccine has only been approved for research purposes. It is concerning that a vaccine clinical trial is implemented as the first phase of the vaccination programme when it is still in its researching stage. How many people are participating in the vaccine programme for Johnson & Johnson? Why has the province not increased government capacity in relation to emergency services such as ambulances? How many additional healthcare workers have been employed in the last year and how many contracts have been terminated that could have an effect on the province’s response plan for COVID-19? Are there any spoiled or damaged doses of the vaccines from Johnson & Johnson? What role does the Free State’s PDoH play in the decision to reopen schools within the province? Has the Free State’s PDoH ever noticed a misreporting of the amount of deaths related to COVID-19 within the province?
Ms G Tseke (ANC) thanked the Free State’s PDoH for the work it is doing in saving the lives of people affected by the COVID-19 pandemic. She also appreciated the work that the frontline healthcare workers are doing in the fight against the pandemic. How does the province conduct its screening processes and are community workers still working on a door-to-door basis? It is important that the information regarding the health and safety protocols, like hand washing and the wearing of facemasks, are spread as widely within the Free State province. How are the hotspot areas within the province being addressed? There have been reports from other provinces indicating the inability of the private healthcare facilities to cope with the high admission rates within hotspots during the peaks of the waves of infections. How far are the scheduled upgrades to the hospitals that the Free State’s PDoH decided on in lieu of building a field hospital? What is the extent of the corruption relating to the procurement of PPEs in the province and what has been uncovered in this regard by the Special Investigations Unit (the SIU)? Has any official been charged?
Ms M Hlengwa (IFP) asked when the public will be informed regarding the number of dosages of the vaccine that the province will receive. What is the outcome of the studies regarding the effectiveness of the vaccine within the Free State province? What plans have been put in place to address the lack of human resources in the Free State’s healthcare facilities relating to the poor performance on key strategic programmes? What plan has been put in place to mitigate the effects of this poor performance on key strategic programmes?
Dr S Thembekwayo (EFF) stated that the lack of adequate PPEs remains a concern as it affects the working conditions and compromises the safety of healthcare workers. What has been done to solve this problem? There are various reports from healthcare facilities regarding insufficient or broken equipment or even hand-washing basins that are not operational. This seriously impairs the adherence to health and safety protocols as nationally required in response to the COVID-19 pandemic. Community healthcare workers have reported that they are struggling to get access to their salaries. The MEC for the Free State’s PDoH stated that additional healthcare workers would be employed on a contractual basis. This is problematic when there are existing issues of being unable to pay existing employees. Have there been any results from the clinic trials for the Johnson & Johnson vaccines within the province? This issue must be explored, especially regarding the recipients of the vaccine that have experienced a negative reaction. How is the Free State’s PDoH intervening in the cases where public health facilities do not even have access to water or electricity? He asked what the plan was to ensure that the vaccination programme reaches the rural areas of the province.
Ms E Wilson (DA) appreciated the presentation by the Free State’s PDoH. She agreed with the concerns raised by other Members regarding the fact that the Johnson & Johnson vaccine is still in a research phase and conducting clinical trials. Are the healthcare workers who are currently vaccinated properly advised that they form part of a clinical trial and that it is not compulsory for them to be vaccinated at this stage? What is the plan for the Free State’s PDoH to ensure safe disposal of medical waste relating to the vaccine? It is entirely unacceptable that one ambulance within the Free State province is expected to cover thousands of kilometres in its areas of coverage. This matter must be addressed with urgency. She asked for an update regarding the delays in the mortuaries within the province.
Dr K Jacobs (ANC) appreciated the preparedness of the Free State’s PDoH. What are the procurement processes that have been followed for the acquiring of the refrigerators for storing the vaccines? He expressed doubt whether the public health facilities in the Free State will be ready for the next wave of COVID-19 infections, especially in the rural areas of the province. What are the plans to deal with the decommissioned field hospitals that have already progressed in its completion?
The Chairperson welcomed the province’s plans to vaccinate all healthcare workers as the first line of defence against the virus. He asked the Free State’s PDoH to address the issues raised by Members regarding the Johnson & Johnson vaccine that is still in a research phase and conducting clinical trials. He asked whether the Free State’s PDoH have derived value from the deployment of Cuban doctors within the province and asked for an update on where in the province these doctors have been deployed. Has the Free State’s PDoH considered the deployment of the Cuban doctors to the rural areas of the province to ensure that everyone within the province have basic access to healthcare services and vaccines?
Response by the Free State’s PDoH
Dr Motau responded that the Free State’s PDoH have received the deployment of 17 Cuban doctors within the province, and they have been allocated to various healthcare facilities in the province, including its rural areas. He stated that the province has undoubtedly derived value from the deployment of Cuban doctors from the team that is assisting the country in the battle against the COVID-19 pandemic. He stated that the healthcare workers within the province have reported COVID-19 fatigue in the fight against the pandemic. The Free State’s PDoH reported that there is a degree of fear and uncertainty amongst the healthcare personnel regarding the safety of going to work and whether they would be able to return to their homes in a healthy condition.
The Free State’s PDoH provides psychosocial support to healthcare workers through its psychiatric facilities. The help of the MEC for Health and the Premier of the province have been enlisted to engage with the healthcare workers and ensure that there is the requisite support for the role that these workers play in the community and the fight against the COVID-19 pandemic.
He confirmed that there is an enormously high demand for hospital beds, and the need for the National Health Insurance can be seen in the disintegrated nature of the country’s healthcare system. It is the task of the public health sector to take on those patients that cannot be admitted in private healthcare facilities, as it is the custodian of health in the province. The Free State’s PDoH is in the process of decommissioning the field hospital. In response to the questions on the disposal of medical waste, he stated that the Free State’s PDoH has an ongoing contract in that regard. However, in light of a possible resurgence of COVID-19 cases, the Free State’s PDoH will have to engage with the contractor in that regard. The Free State’s PDoH ventilates these issues on every platform, including during engagements with National Treasury.
Regarding the concerns expressed by the Committee on the amount of ambulances available and its extensive coverage areas, he stated that the Free State’s PDoH is in a dire need of additional ambulances. The rule is that there must be at least one ambulance for every 10 000 people in the population. The province has a population of 2.9 million people, which requires 290 ambulances but the province is operating only with 149 available ambulances. The Free State’s PDoH has been in engagements with the National Treasury regarding its budget allocation, but it is clear that there is not enough funding for the province for adequate managing of its healthcare services.
He stated that there are private and public mortuaries in the province. The problem with delays relates to the lack of specialists to perform autopsies and the issues relating to forensics that causes long waiting times. The province does not have extensive problems with its supply of oxygen.
Regarding the questions on the province’s poor performance on its key strategic programmes, he stated that there are serious implementation plans that must be developed to rectify the consequences. It is crucial that plans be developed to deal with the situations where people can get their medication on time for their underlying diseases, such as Tuberculosis and HIV/AIDS.
The budget cuts for the Free State’s PDoH remain severe, and during the last calendar year a loss of R950 million was experienced in the midst of the pandemic. This required a reprioritisation of how the Free State’s PDoH will appoint additional staff members or procure the necessary goods and services. The COVID-19 pandemic has highlighted the people’s dire need for a National Health Insurance. The Auditor-General of South Africa (the AGSA) audited the ambulance service tenders and found no irregularities found. Only one medical helicopter is operating within the province.
Regarding the questions on the clinical trials of the Johnson & Johnson vaccines, he responded that the healthcare workers who are vaccinated are informed properly of the risks involved. The clinical trials have proven to be safe and effective all over the world. However, there is a need to depend on other vaccine providers to ensure that an adequate population is vaccinated to ensure that the country is protected in the future. The Free State’s PDoH have appointed over 200 interning doctors to assist the current healthcare staff complement. The Committee will be provided with a report in this regard and its impact on the service delivery in the province. He stated that there has been no discovery of any corruption regarding the Free State’s PDoH. The processes of procurement is centralised within the Free State’s Provincial Treasury.
Ms Grace London, the Chief Director for the District Health Services, Free State PDoH, stated that the stipends of all community healthcare workers have been paid. The delays were as a result of fraudulent information provided that required the Free State’s PDoH to liaise with the South African Police Services.
The Chairperson thanked the Free State’s PDoH for its briefing and responses to the questions and concerns posed by Members. He stated that the Committee welcomed the province’s plans to vaccinate all healthcare workers as the first line of defence against the virus. The Committee appreciated the report that some of the unresolved issues from previous engagements with the Free State’s PDoH have since been attended to, such as emergency medical services although further interventions are required. He welcomed the reports that the Free State was deriving value from the deployment of Cuban doctors, after the province was allocated 17 doctors from the team that is assisting the country in the COVID-19 pandemic.
Consideration and adoption of meeting minutes
The last item on the agenda was for the Committee to consider and adopt its outstanding minutes for its previous meetings. The Committee adopted its outstanding minutes for its meeting of 24 February 2021.
The Chairperson thanked the Members, support staff and guest delegates for attending the meeting.
The meeting was adjourned.