Mpumalanga Covid-19 Update and Vaccine plan


17 February 2021


Mpumalanga DoH: Status of Health Care Services in Relation to Covid-19 and Vaccination Roll out Strategy 

Meeting Summary

Video: Portfolio Committee on Health

The Committee received a briefing from the Mpumalanga Provincial Department of Health on the health care services in the province, with a specific focus on the way in which they were handling the COVID-19 pandemic and the vaccine roll-out strategy.

In a virtual meeting, the Department took the Committee through detailed statistics concerning Mpumalanga’s increase in cases, the recovery rate and the amount of laboratory tests performed. The province had been seeing a decrease in new infections. Females accounted for 56% of the cases in the province, and the majority of the cases (26%) were in the 30-39 age group. During discussion, it emerged that 6 641 (10%) of the cases tested as positive were children under the age of 19. The first 80 000 doses of the Johnson & Johnson vaccines were expected to be dispatched to Mpumalanga on Wednesday, 17 February, and frontline health workers would be prioritised for vaccination

Members were concerned with security issues surrounding the vaccine roll-out, such as the disposal of empty vaccine vials to ensure they were not filled with a saline solution – as had happened elsewhere – and resold as the genuine article. They also wanted an assurance that controls were in place to ensure the type of corruption experienced with personal protective equipment (PPE) did not recur. They heard that the Department had received significant support from the surrounding mines, the private sector and the community in coping with the pandemic.

Other issues which elicited comprehensive replies from the Department included the vaccination readiness and bed availability of the hospitals; Cuban doctor placements and community health workers being absorbed into the system; screening at roadblocks; field hospitals and quarantining; the backlog in Covid-19 testing; how mortuaries were coping with the increased number if deaths; the involvement of traditional leaders and organised labour in the vaccine roll-out plan; and the effect of the recent heavy rainfall on the province’s health facilities.

Meeting report

The Chairperson asked for support for his proposal that the Committee have a meeting on Friday to approve all the outstanding minutes of the meetings they had held. He had asked the Committee Secretary to start sending the minutes to the Members so that they could read them and be prepared. He predicted that it would not be a long meeting, as there were only about five agenda items so it might last only an hour. 
Mpumalanga Covid-19 Update and Vaccine plan
Ms Sasekani Manzini, Mpumalanga MEC for Health, thanked the Chairperson for the opportunity to present on the state of the province’s health and COVID-19 management.

With regard to the vaccine plan, she confirmed that the Mpumalanga Department of Health (MDOH) would be receiving the vaccines on that day, and launching the roll-out the following day. The South African Medical Research Council (SAMRC) would be assisting the Department. They had been able to manage COVID-19 with help from the Premier, and by working with key stakeholders. They were continuing to make sure that they limited the spread of COVID-19, and had launched a clinic-based model that had assisted them greatly in managing the health care system in the province. COVID-19 had showed that the public health system could provide quality services, and that together they could fight the pandemic.

Status of health care services in relation to COVID-19

Presentation: Briefing by the Mpumalanga Department of Health on the Status of Health Care Services in Relation to COVID-19 and Vaccination Rollout Strategy

Dr Savera Mohangi, Head of Department (HOD), MDOH, briefed the Committee on the status of health care services in relation to COVID-19 and the province’s vaccination roll-out strategy. She provided an update on the statistics regarding COVID-19, referring to the global death rate for COVID-19 at 1 February 2021 at 108.6 million, of which South Africa accounted for just over 1.4 million. Deaths in Mpumalanga had amounted to 69 045.

She took the Committee through detailed statistics concerning Mpumalanga’s increase in cases, the recovery rate and the amount of laboratory tests performed. Mpumalanga had been seeing a decrease in new infections. She reported that females accounted for 56% of the cases in the province. Overall, the majority of cases (26%) were in the 30-39 age group.

The first 80 000 doses of the Johnson & Johnson vaccines were expected to arrive on the evening of Tuesday, 16 February, and would be dispatched to Mpumalanga Province on Wednesday, 17 February 2021. The province had identified two vaccination sites for the vaccine rollout plan -- Rob Ferreira and Witbank hospitals -- due to the limited stock of the vaccines. These hospitals were chosen for their high number of healthcare workers who had been exposed to COVID-19. Mzansi Ethical Research Centre (MERC) had been nominated to oversee the vaccination process in Mpumalanga. The rollout programme would be implemented over a maximum of two weeks. A team of 42 vaccinators would rotate between the two facilities, which in turn would be overseen by researchers from the MERC. The research team would assist in maintaining the cold chain and drawing up doses of the vaccine, and the vaccinators would then administer the vaccines.


Ms E Wilson (DA) asked for clarity on the comparison between home deaths and hospital deaths from COVID-19. She asked for an update on the situation with regard to the waste disposal of the COVID-19 vaccine vials. There were a lot of concerns in other provinces with regard to the disposal of the vials and whether special plans were being made to dispose of them, as they had had many instances in China where people had stolen the empty vaccine vials, filled them with saline water and were selling them to people who were desperate to get the vaccine.

She raised a concern regarding the minutes. She had heard that they had to have them signed off by the end of the week, but it was very difficult to get the minutes, and they were having to try to remember what had happened in a meeting in April last year. It was unacceptable, and this was one of the situations that they wanted to raise when they had their private Committee meeting, which they had asked the Chair of Chairs to attend. She had read through those minutes, but it was very difficult to ascertain or try to remember what actually happened in a Committee meeting a year ago, particularly in light of COVID-19.

The Chairperson responded that they would try to engage with the House Chair and hear what other Members say on the matter, because COVID-19 happened and they could not predict they would have had a delay with getting the minutes finalised.

Ms G Tseke (ANC) expressed appreciation for the presentation, and commended the hard work the MEC and HOD had been doing. She appreciated the clinic-based model that had been launched, because it was comprises of all the stakeholders in the different worlds and those forums would spread the information and make sure all the COVID-19 protocols were being implemented. She referred to a region where Covid cases had been lower than other regions, but the death rate had been higher, and asked for a reason for this anomaly.

It should be their collective responsibility to strengthen the educational campaigns and reinforce the work of the clinic-based model. There were 33 hospitals in the province, but only 31 had been identified in the vaccination rollout plan. Why was there this discrepancy? What measures were being taken to prevent vaccine tender corruption? What support was the province getting from the mines? How would private health hospitals be included in the first phase vaccination rollout plan, or would they be managing it separately? On the shortage of transport, were there sufficient ambulances to deal with COVID cases? Were there any Cuban doctors in the province as part of the intervention by the National Department of Health? What was the status of Community Healthcare Workers (CHWs) in the province?

Mr P Van Staden (FF+) commented that for phase one of the vaccine in Mpumalanga, they intended to vaccinate 69 000 health care workers, but they would have to set new timelines because of the problems with the vaccines. When would the new timelines be available? When would the new phases be completed in Mpumalanga? How many of the 80 000 Johnson & Johnson vaccines would Mpumalanga receive at this stage? Departmental transportation looked like a big problem in this province. What was the procurement status of extra and new vehicles for this Department? The presentation had mentioned screening at roadblocks, and he had received a complaint via telephone that there was no social distancing at the roadblocks. As a Department, how were they overseeing this project, or did the South African Police Service (SAPS) handle it completely on their own? What was the status of their field hospitals and quarantine facilities? What was the status of new interns for 2021 in Mpumalanga? What was the status of personal protective equipment (PPE) per clinic and hospital in Mpumalanga? Did they have any laboratory testing backlogs and if so, what was the latest number, and how many days or weeks were they behind?

Ms H Ismail (DA) how much PPE tender corruption had been uncovered by the SIU in the province. Had any officials been charged or held accountable? There had been allegations of vaccine tender corruption -- had the Department investigated any irregularities regarding vaccine tender corruption thus far? What preventative measures had the province put in place to ensure that there was no possibility of corruption going forward? How many vaccines would be given to the private hospitals, and would they have their own vaccine roll-out programme, because the presentation had not covered private hospitals? She understood that the Department was focusing on public hospitals right now due to the number of vaccines they were receiving, but she asked for an update on the matter. The presentation had not address Emergency Medical Service (EMS), and she asked for a report on how they were coping with the spike in cases due to COVID-19 and attending to normal services.

Referring to intern doctors, she asked how many, and where, they had been placed in the province. Had these intern doctors been paid their normal salaries and for any overtime that they had worked? This was becoming a major problem throughout the country. Had the Department considered appointing community service doctors who had finished their community service term? If yes, how many had been appointed, and if not, why not? The issue of the Cuban doctors and their placements had already been asked. How many people in the province needed to be vaccinated to ultimately achieve herd immunity? This would make it easier for the Department to lay out plans for the future once more vaccines were procured. Considering the health care workers’ infection rate and the COVID-19 deaths in public facilities being far more than in the private sector, could this be attributed to a shortage of proper PPE in the first phase when COVID-19 started? She asked for a report on how mortuaries had coped in the province.

Mr M Sokatsha (ANC) addressed the communication strategy that had been referred to in the presentation. He asked that the MEC elaborate on the strategy because he was interested in how the province was ensuring the information was getting through to the far-flung and rural areas in Mpumalanga, with an emphasis on information about the vaccinations, as there were still fears among people who were stating that they were not going to take the vaccine. The presentation had mentioned the isolation facilities in Mpumalanga -- were the cases admitted to these isolation facilities increasing or decreasing? Dr Mohangi had assured the Committee that they did not have shortages of oxygen tanks in the province, which he was happy to hear.

He addressed the issue of the inadequate human resources, and asked that Dr Mohangi to elaborate on what they were doing as a Department to ensure that they were addressing the staff shortages. How many staff had been trained in relation to the distribution of the vaccine? The Head of Department had indicated that the health workers would be receiving their vaccinations that day. Did they have enough vaccines to vaccinate all the health care workers, or would there be a shortage? Had the Department received any donations towards addressing COVID-19?

Dr S Thembekwayo (EFF) referred to the announcement that was made to say that one of the two hospitals that would be receiving the vaccines was the Witbank hospital. On social media, Witbank hospital had been portrayed as being very unhygienic. Was anything being done to improve on the hospital’s hygiene? Due to COVID-19, people were meant to sanitise and be able to keep clean at all times. The situation at Witbank needed to be attended to. Had the Department addressed the shortage of staff and beds at Witbank, which was also an issue that had been identified there? How many health care workers had registered successfully on the online application system to receive the vaccine, as there were contradictions in the figures reported?  They needed to know their plan to roll-out the vaccine, because it was not clear.

Recently they had experiences problems due to severe rain in the province. Were any health facilities affected by this, or was it affecting service delivery in the province specifically with the vaccine roll-out plan? Had they run any trials in the province to test the efficacy of the vaccines? How many Cuban doctors were deployed in the province, and how were they utilised? How were the traditional healers incorporated in the roll-out plan? She had received concerns from people that in some of the hospitals in Mpumalanga, people who were tested and found to be positive for COVID-19, were given R22 000, She had asked the National Department of Health about this, but they advised her they did not know anything about it. She asked for clarity regarding the situation.

Ms A Gela (ANC) commented that she would speak about the traditional healers, as they were very important stakeholders in South Africa, and it would be wrong to leave them out. How were the traditional practitioners incorporated in the roll-out of vaccine plan? Health care workers were exhausted and working under stress to save lives. What support was the Department giving these health workers? Provision had been made for 10 days to vaccinate staff who were off sick or on leave, but would the same process be used with smaller facilities such as clinics in the province? She wanted clarification on whether the province had a shortage of oxygen supply, as she had heard there was a concern over the high demand for oxygen. How was the Department ensuring that there were adequate supplies of oxygen in the province? What role did the Vaccine Coordination Committee play in the whole process? She wanted to highlight the relationship between the Mpumalanga Health Department and Department of Labour, as they were an important stakeholder. She said she was happy with the Department’s work thus far in responding to COVID-19.

Ms N Chirwa (EFF) commented that there was a persistent problem that was being picked up of the lack of being proactive by the provincial departments of health, and Mpumalanga was no different. In the public hearings of 2019, it was raised one too many times that the EMS was in a serious state in the province, especially in the rural areas and townships. She asked the MEC to explain the distribution of EMS vehicles in the province in detail, how it was ramped up in preparation for the second wave, and how it was currently being ramped up in preparation for the expected third and fourth waves. It was a serious issue, because it persisted on a daily basis and there were daily grievances of people waiting for ambulances that ended up not arriving. The Committee was aware of this particular issue because it was raised one too many times by almost each and every presenter at the National Health Insurance (NHI) hearings in 2019.

How many vaccination sites were currently ready to facilitate the vaccination process? Something that she had picked up from the National Department of Health was that even though there were sites that were named, their readiness was not necessarily a reality. This was also picked up at the Edenvale hospital the last time the Committee was doing oversight there. Where were the vaccination sites that were ready to facilitate the vaccination roll-out, because then they could do oversight to ensure that the readiness was not just on paper, but was a reality?

She raised concern over security at hospitals. The issue of security could not just be left to the Mzansi Ethical Research Centre in relation to vaccinations. In the information presented to the Committee, the Department had failed to outline how they would ensure the security of the hospitals and the vaccination sites generally would be facilitated, during the pandemic and after. If the MERC had to intervene on the Department’s behalf in the province, it was clear that security was an issue in the province and it was not being prioritised. The issue of security in Mpumalanga was much bigger than the issue of the vaccination. Last year November, a 12-year-old boy had raped a five-year-old at a hospital in Mpumalanga. The province was also said to be investigating this particular issue and must not lie and be misleading. Not many years ago a doctor was murdered by a patient in a hospital. Healthcare workers raised the issue of security on a daily basis. How did the province respond to this? Numerous times, the South African Medical Association (SAMA) had recommended the inclusion of a biometric system to ensure that healthcare workers’ medication and the hospital in general were safe, or that there was at least a tracking of people who were entering hospitals. How was that recommendation being adopted by the province?

How many community healthcare workers of the province had been absorbed in the past year? When would they all be permanently absorbed by the province? They were seeing a catastrophic turn of events in the Eastern Cape, where 650 workers had been released and then taken back into the system. They had learned that now 1 000 have been released again and their contracts were not renewed. She asked for a breakdown of how many CHWs they had in the province. How many were going to be absorbed? How many had been added on in the past?

There had been an individual at the NHI hearing in Mpumalanga who had raised the issue of not having access to getting a new wheelchair. Could the MEC update the Committee on this particular case, because she had made a commitment on the day in front of the entire Committee that this particular individual would get a wheelchair. That was in 2019, and it was now 2021.

There was also the issue of the “long drop” system in Mpumalanga. Had there been an attempt to create a relationship between the Department of Water and Sanitation (DWS) and the Provincial Department of Health in Mpumalanga, considering that these issues were interlinked? This was what she meant by the fact that the province was not proactive. They always waited to be given a criterion, and could not think for themselves. They had the issue of long drop systems in their schools, in rural areas and in public facilities. What had been done to counter this, because it contributed to the issue of health in Mpumalanga?

She referred to the issue of food parcel corruption by local ward councillors which had been raised last year. What had been done by the province in response to this kind of culture that had not been attacked and confronted by the province, especially during a very tough time globally? What had the province done to not only confront and counter the situation, but to ensure that the compromised families and individuals in this particular debacle were supported by the Department of Health? They must not sway away from the fact that the Women’s Charter, the Bill of Rights and the Constitution all refer to nutrition and health, so they must always find a way to ensure that this particular link was not erased because the provincial Department and non-governmental organisations were not able to deliver on it. It was one of the Department’s primary obligations and mandates. What had been done by the province to ensure the corruption by these local ward counsellors of the ANC was stopped, as the immune systems of the individuals who did not get food parcels were compromised?

Mr T Munyai (ANC) supported the Chairperson’s proposal that the Committee needed to look at the minutes on Friday to comply with everything. Even if a lot of time had passed, they did not forget their appropriate resolutions because the staff prepared the minutes. They would have gone through the records. It would be good governance to approve the minutes in a meeting on Friday.

He commended the presentation which reflected the preparedness on the side of the MEC and the entire team. He raised the issue of the availability of oxygen, which seemed to be a major problem across the country, but in Mpumalanga they seemed to be COVID-ready, and oxygen was available.

He raised the issue of the shortage of staff across the provinces, not only in Mpumalanga. Funding across the provinces was very challenging because when the mistakes happened, one tended to point at the leadership of that province, but they knew that the budget was not limitless and evenly spread across the province. If they were to argue with the Minister of Finance and the Minister of Health, it would be to say that the budgets of the respective provinces should be proportionately increased to deal with the human resource aspect.

The Chairperson commented that the vaccines had arrived that night, and they were already dispatched to the provinces. He was going to check with Professor Glenda Gray, who was also part of the team, as to whether there was a need to quarantine or not, and they would be appraised by science on that. Did the Department have enough diesel in its hospitals that had backup generators? He was glad they were mentioning Rob Ferreira as one of the hospitals that they would be using. He would imagine that the infrastructural challenges at that hospital about three years ago had since been sorted out.

Department’s response

Dr Mohangi declared upfront that she would not be able to answer some of the questions immediately. She committed to sending some of the responses in writing. 

Comparison between home deaths and public facilities

She said there had been an interesting question about the number of deaths that they were seeing in Gert Sibande. They had recorded about 104 deaths at home, and had noticed that in Gert Sibande many of them were not reporting being sick to the institutions. When they reported it to the Department as per protocol, they would send the team to do the swab and declare them as COVID-19 related deaths if the tests came back positive. They had noticed in Gert Sibande they were having the challenge of patients coming in late. When the first wave happened, it had been very cold in Gert Sibande, and it was in the areas where it was extremely cold where they had noticed most of the deaths as well. Emalahleni had been a major hotspot, especially when the mines opened, and hence when there had been increased cases, and the death rates had also risen in that area.

Waste disposal of empty vaccine vials

They had a company that was doing their waste disposal in the province, and had made arrangements with them to bring separate boxes for the vials’ removal. That company would be present with them during the period of the vaccine administration, and would remove them immediately so they would not be stored in their facilities.

Only 31 of 33 hospitals being used for the vaccination roll-out

One was a very small hospital which did not have sufficient storage space for the vaccine. The other hospital, Sesifuba, was also very small, and was now even incorporated into the Ermelo hospital, so they would not be doing the roll-out separately.

Vaccine tender corruption

The vaccines were not being procured by the province. They were receiving the vaccines from the National Department of Health.

Assistance from the mines

The MDOH had been getting much assistance from the mines. Facilities which had been supported included the intensive care unit (ICU), and great donations in the form of personal protective equipment (PPE). The mines had been assisting them with contact tracing. They had also been building clinics, especially in the nKangala district. Even the Stafford farm had assisted them with isolation and quarantine facilities. This response was linked to the question that had been asked about the donations. The Department had received a lot of donations from the mines and others in the private sector as well, and they had declared these donations to the National and Provincial Treasury on a monthly basis with their reporting.

Private hospitals involvement in first phase of the vaccination roll-out plan

The response they had received from the National Department of Health was that the private sector was not comfortable about joining the public sector to receive their vaccinations, and they would be part of the second part of the first phase. In the next 80 000 vaccinations that would be received by the National Department of Health, part would be allocated to the private sector. Currently, the way the teams were working was that there was a work stream at the National Department of Health that was dealing with the private sector, and the province had started to have meetings with them as well so that they could be updated on the role of the private sector in the provinces as well.

Shortage of transport

Dr Mohangi  said the Department procured ambulances in 2019 and 2020. They had received about 66 EMS and planned patient transport vehicles, in order to assist them with ambulances. They had allocated ambulances per district specifically for COVID-19 related cases. During the peak of the first phase, they did have a challenge in the nKangala district, and had had to allocate two ambulances. They also allocated vehicles if there was a need to deal with the number of cases they were experiencing.

Cuban doctor placements

They had received 13 members of the Cuban brigade, and 10 of them were family physicians that had been allocated to their institutions. There were two biostatisticians and one epidemiologist who were assisting the teams in the provincial office with the pandemic.

Community health workers

The CHWs had been included in the Personnel Administration (Persal) system on 1 April 2020. There were some challenges they had experienced, such as problems with their banking details, duplicate identity documents (IDs) and so forth, but they had managed to resolve those and pay all of them. Currently there were about 6 119 community health workers that they had taken over from the non-governmental organisations (NGOs) that they were funding. They were being paid the minimum wage at the current stipend rate of R3 633 on a monthly basis.

New timelines, and when they would be completed

This was going to depend on how they received the vaccines from the National Department of Health in terms of their allocation. In the first round, they were receiving 2 000 doses for Rob Ferreira and 840 for Witbank hospital to cover the number of staff that were on the Persal system. In the next round, when the next 80 000 was expected in another two weeks, they would see where they would be allocated, and which hospitals would be identified for the next round, and they would be able to tell the Committee when they would be able to complete vaccinating all their healthcare workers. 

Subsidised vehicles shortage

They agreed that there was a challenge with the vehicles. They were having problems with subsidised vehicles with the national tender. That was also being resolved because they were starting to see that some of their staff were receiving the subsidised vehicles that had been applied for. They had spoken to other departments as well to assist them, because with the community screening and the contract tracing there were also new activities that were part of the daily processes in the districts, and there were not sufficient vehicles at that time. In this financial year, they had prioritised EMS overflow vehicles and they hoped that in the next financial year, budget permitting, they would be able to replace and procure new fleet vehicles for the Department.

Screening at roadblocks

In the beginning there were some complaints they had noticed in social media about not being compliant with social distancing, but they were now complaint. It was the responsibility of their staff and whoever else was there at the screening to ensure that they were maintaining social distancing so that if there were any complaints again, they could address them individually. They had been training all their staff to ensure that social distancing and mask wearing was emphasised. 

Field hospitals and quarantining
As a Department, they did not build separate field hospitals. They identified hospitals that were not being fully utilised. They looked at their tuberculosis (TB) hospitals which were not being fully utilised, and the decentralisation of the TB management as well. They had upgraded these TB hospitals to service the field hospitals. They had used the Barberton TB hospital where there were about 90 beds. They had used the Standerton TB hospital as well, where they had renovated it and were able to use it, but none of them at the moment had been filled with COVID-19 positive patients. There was a hospital in Emelahleni that had not been fully utilised, and they were also busy with renovations so that it could be used for COVID-19 patients as well. They had a new eye ward at Tonga hospital, but before it could be used as the eye ward they wanted to make sure they separated it so it could be used for COVID-19 patients if needed.

There were no field hospitals that they needed to decommission because they had not built anything that was new, but had used what they had available. Once the pandemic was over, these facilities would be used for their normal day-to-day activities again. With the quarantine sites, they had used their sites as well like the Mpumalanga Regional Training Trust (MRTT) and the Mpumalanga Tourism and Parks Agency so that they were able to save in terms of outsourcing. The Department of Public Works had also identified the private institutions they were able to use for quarantine. They currently had five sites for isolation, and there were only about 40 patients that were in those sites, and the numbers were decreasing. If there was a need, they would be able to discuss it with the Department of Public Works, so they could get more isolation sites if they were needed in the private sector as well.

New Interns

Dr Mohangi  said the Department employed the new interns which had been allocated by the National Department of Health. All their posts that had been accredited by the Health Professionals Council of South Africa had been filled with the new interns, and they had had no challenges with their payment. There were some delays in terms of their overtime payment at the end of January, but all of them were paid their overtime at the beginning of February.

PPE availability in the province

They were monitoring the PPE on a daily basis. Currently they had 93% availability. She gave a breakdown of the different categories of PPE and where they were. 

Relationship with organised labour

The MEC met with the unions regularly every two weeks, where she gives them an update on the PPE, the Occupational Health and Safety committees, and the statistics. They were monitoring the PPE at the facilities and if there were any challenges that arose, they would bring it to the attention of the MEC or herself immediately so that they were able to address them. The relationship with organised labour had been very good since the committee was established, and they have not had any challenges or complaints about the lack of PPE. There were some instances where they had challenges with the quality, but those had been withdrawn and the PPE was replaced.

COVID-19 tests

There was a backlog as of yesterday of about 671 specimens, broken down into 476 for one day, 97 for two, and for five days it was 15. This was for the tests by the National Health Laboratory Services, and it had improved. It had been quite bad, but subsequently the turnaround time had improved. 

PPE corruption

From the Special Investigating Unit (SIU) report, there had been an issue mentioned about two officials against whom disciplinary action needed to be taken. When they had had discussions with the Chief Investigating Officer, she had indicated there were other reports that were coming in, and that they should delay the disciplinary action because it may be the same officials that were implicated, and they could then take disciplinary action together, rather than individually. They were waiting for those reports which the SIU had promised would be coming in the near future. 

Vaccine tender corruption

The Department was not procuring vaccines. It was being procured by the National Department of Health, so there had been no tender that had been advertised or any vaccines procured by the province itself. 

Private hospital vaccination rollout plan

Dr Mohangi said, as mentioned in the first part of the presentation, the private sector was not going to be involved in the first phase. They may be involved in the next part, which would be the next 80 000 vaccines that would be received in the next two weeks. 

Detailed report required for the EMS services

They would be able to send the link as to how they distributed the ambulances, the number of stations they had, and how many ambulances they had per station.

Detailed report on quarantine sites and where interns have been placed

She committed to delivering this report as well.

Appointment of qualified community service doctors

They had appointed only those who were their bursary holders. The reason was the funding challenges they had as a Department and as a sector, as they were unable to appoint all the community service doctors or absorb all the community service workers. They were making sure that where they had invested in terms of bursaries, they appointed those community health service officials and doctors that would be able to assist the province. 

Insured and uninsured vaccines

She committed to following up on the issue, as she did not know the exact statistics.

Deaths in the public sector as a result of a shortage of PPE

They did not have a shortage of PPE in the province in the public sector. There had been no complaints received from organised labour in that regard. 

How mortuaries had coped

They had not had any major issues at the mortuaries. They had a good relationship with COGTA and the local municipalities. When challenges did arise, they were able to address them together collectively. 

COVID information disseminated to the rural areas

They were procuring regular community radio slots and providing the information through the local radio stations so that the people in the rural areas were able to understand it in their languages.  They also have the clinic-based model. The local counsellors also assist them in disseminating the information that was needed.

Isolation facilities

These were decreasing because the need for isolation facilities had now also decreased.

Oxygen supply

There was no shortage, and they had not had a real challenge with oxygen in the province. All their tanks had a trigger linked to Afrox where, when the oxygen reaches 50%, Afrox refills their oxygen cylinders. They place their orders on a weekly basis.

Staff shortages

There were major shortages of staff. Unfortunately, the current budget did not allow them to appoint more staff. In this financial year during the second adjustment, they had taken a budget cut of R534 million on costs of employment (COE) alone, which made it impossible for them to appoint further staff. If one looked at the allocation for the next financial year from National Treasury, their Department had taken a budget cut of R1.2 billion for COE only. By looking at that amount of money, it was impossible for them to be making further appointments at the current level. Any assistance in trying to make sure there were no budget cuts for health would be welcomed so that they could appoint as per their plan.

Number of vaccines versus the number of health care workers

Dr Mohangi said the province would be getting 2 000 vaccines for Rob Ferreira hospital, which would be sufficient to vaccinate all the employees if they consented to the vaccination, because they had 1 738 on Persal in Rob Ferreira. The 1 640 they were getting for Witbank hospital was also sufficient for all their staff.

Witbank hospital being portrayed as unhygienic

The MDOH had sent a team there and investigated, and they had gone to the root cause of the problem. They have managed to appoint staff in that facility. The challenge they also had was being unable to get water for the hospital. It was a municipal problem of the whole of the Emalahleni district where there were challenges with water as well. As a Department, they had also put up more tanks at the institution, and they had had no further challenges with water shortages. 

Healthcare workers registered successfully on the EBIS

She did not have the full number of registered workers with her at that moment, but had spoken to the National Department of Health as well so that they could be able to get them registered on the Employee Benefits Information System on a regular basis. They had been popularising it with their staff through their communication to ensure that all of them were registering. They had asked the hospital managers to assist those staff that may not have access to a computer to register as well. 

Effect of rainfall

It was true that many of their facilities had been affected by the rainfall. There had been leakages in many of their hospitals, as well damage to other facilities because of flooding. The rains had been extremely excessive in the last two or three weeks due to the cyclone Eloise. Vaccine delivery in the first phase was not going to be affected, but they were busy with maintenance and the repair of all the damage.

Efficacy of the vaccine 

As a Department, they would not be doing any trials to test the efficacy of the vaccine. This was why MERC was involved, because they were the ones that had been enlisted for the trial, and who would be administering the vaccine and taking records.

Traditional leaders’ involvement in the vaccine roll-out plan

They Department had plans to start engaging with the traditional leaders, but they had been asked by the National Health Department to hold off on those plans because they were engaging with them at a national level through the different forums. As a provincial department, they were also engaging them to see who would agree to be part of the plan, and they would be regarded as essential workers when they were rolling out the plan. 

Allegation of healthcare workers being compensated R22000 for being COVID-19 positive

Unfortunately, they were not aware of this. There had been no compensation by the MDOH of R22 000 to any official, so if there were any specific allegations they could be given to them and they would investigate them.

Support provided to healthcare workers

The MDOH provides counselling as and when needed, and the healthcare workers had also formed their own support groups. This was also assisting them to handle the stress they were working under.

Readiness of the vaccination sites

Dr Mohangi said 31 hospitals had been identified. They had identified where they would be doing the vaccinations and the number of vaccinators per site. They agreed that once they started, there may be problems that they experience, and they would be able to address them from time to time because this was the first time they were going to be doing something on this scale. They could provide the information on all the hospitals they were getting ready for the first phase. 


Security could not be left to the Mzansi Ethical Research Centre. It was not that they had contracted MERC to do the security or to take over the security from the Department. This had been agreed upon at that level because MERC was conducting the trial. It would be responsible for the vaccines in the sense that they would be giving it to the province, because it had not been registered. The MERC had been the entity that had done the application and had been successful in ensuring that this vaccine would be given to the healthcare workers. The MERC would be taking on that responsibility -- not that the Department was shying away from their responsibility as a province. Even during the administration of the vaccine, it was not even going to be the Department’s officials who would be drawing the vaccine -- it would be the MERC investigators themselves, because of the regulations. The Department’s vaccinators would then just inject the vaccine.

She agreed that there were challenges of security in their institutions. They had appointed service providers in all the districts who would be assisting them to start with the hotspot areas, so that they could put their CCTV cameras in those areas. The Premier had also provided funding to allow them to install turnstiles at their institutions as well

Access to the wheelchair

With all the issues that were raised by the community, they had taken their names and had addressed the issues. If there was anybody who had not received a wheelchair or if there were any issues anyone had brought up, she asked that they send details to them so they could follow up. 

Long drop system

The Department of Education was addressing the problem at the schools to make sure they did away with the long drop system. 

Food parcels corruption

Unfortunately, she could not respond to this issue because it fell under the Department of Social Development. 

Supply of diesel

They had enough diesel currently. They monitored the diesel in their facilities on a weekly basis to ensure, especially with the load shedding, that there was enough diesel in their facilities. They also did testing of their generators on a weekly basis to ensure there were no challenges. Currently they had no challenges with diesel, and their director was also actively ensuring that they were keeping an eye on it. 

Rob Ferreira Hospital and its challenges

Many of the challenges had been resolved. Some of the areas were still under construction. Where they have had challenges, those had been escalated to the Department of Public Works. They had had challenges in one area that was being constructed, and the contract was eventually terminated, and a new contractor appointed. Many of the infrastructure challenges had been resolved, but the hospital was still under renovation, so not all the challenges had been resolved for now.

Organised labour

Ms Manzini said that she personally attended the meetings with the unions, and ensures she updates organised labour on everything they were doing as a Department as far as COVID-19 was concerned. This had resulted in their meetings taking less than an hour, because the challenges they had when they started were being resolved. They did not have issues with PPE in the province because they had started giving organised labour a daily update on all the PPE in their facilities. They also had direct communication with organised labour. Even as far as the vaccine rollout was concerned, the strategy that she used with organised labour was that even before she goes to present to the executive committee (EXCO), she consults with organised labour. She takes their input before she goes to ESCO. As far as working with organised labour and representing the workers, they had a good working relationship which had helped them in managing the pandemic.

Community healthcare workers

When they started with the community healthcare workers, they were on a contract with non-profit organisations (NPOs). They had waited for the contract to end and when it did, they could then put them on Persal. The issue of absorbing the community healthcare workers was being discussed at a national level because of the challenge of the budget constraints. They understood the work the community healthcare workers were doing was assisting them as a Department, especially during the pandemic. They had to thank them for the good work they had done, so they had been prioritised as far as PPE was concerned. 


They want to thank the Premier, because they had come into the space and assisted them in making sure that their workers were safe. They had changed the system they used before, where people were parking inside the hospital, because that was where the public could go into the hospital with firearms. There were a lot of changes they were making to ensure that the workers and patients were safe. 

Traditional healers

When she arrived in the Department of Health, there had been no structures. They had launched the structure, starting from the municipalities to the districts to the provinces, and she had personally communicated with the traditional healers. When the country was at level 5, they had had meeting where they were complaining about payments. They had assisted them and also had training so that they could prevent themselves from being infected with COVID-19. They were consulting and working with them. They were having discussions regarding the vaccine and at what stage were they going to get the vaccine. They would be prioritised to be vaccinated in the country and the province.


Emergency Medical Services had been a problem in the province since she arrived in the Department, with issues like buying ambulances and the planned patient transport that they had introduced. She had made her contact details available to the community, and they used to call her every day and night. These days she could say the calls have reduced because of the effort they had put into resolving the issue. People were also complaining about the EMS response time from the call centres, which was something that they had improved on as a province. The ambulances that were being used to transport patients from one hospital to another were the same EMS ambulances that were supposed to respond to emergencies, so now they had the planned patient transport which would then alleviate the ambulances so they could focus on emergencies.


She confirmed that she was leading the communication in the province. It was not only at the provincial level, but also at the local level because she believed that was where they had to communicate the most. Community healthcare workers were also creating awareness when they did the door-to-door screening and educating people as far as health protocols were concerned, which was assisting them during the different levels of lockdown when they could not coordinate big meetings. The Department had also launched the clinic-based model, where the different stakeholders were there at the clinics. It was a platform they were using where they had traditional leaders, religious leaders, business people and so forth. They had put in place all these structures to help them as a province to communicate any information they needed to.


Dr Mohangi said she was not in a position to specifically respond to the issue. As an MEC, she received a lot of personal requests and most of the people that send requests to her were responded to. She could not specifically respond to the issue Ms Chirwa had raised because there had been so many public hearings and she was also inundated with requests. She would go back and check.


They were prioritising the matter as a province.

Follow-up discussion

Ms Ismail asked for clarity on the HOD’s statement that only community healthcare doctors who had bursaries with the Department were absorbed into the system.  Considering that there was a shortage of healthcare workers, would the Department consider absorbing these community service doctors? They were sitting in a predicament, because they did not have jobs, and at the time of this pandemic, they should use every hand that was available. The contact details would be highly appreciated.

In the presentation, the distribution of cases per age group were indicated, and 6 641 (10%) of cases that were hospitalised were children under the age of 19. Were these children from a particular area of the province? Could they investigate further as to why there were so many?

Dr Thembekwayo asked for the HOD and MEC's contact and Whatsapp details. In the province there were internships for orthotics and prosthetics -- were they being paid a stipend, and how much was it?

Mr Munyai said that since the MERC was responsible for the vaccination rollout in Mpumalanga, he proposed that at some point they may have to request the MERC President to come and present to the Committee in order to get more details. He was not suggesting that it should be done immediately, but rather in alignment with the Chair's programme.

The Chairperson said that he had sent the contact details for the MEC. Generally speaking, when Treasury made cuts to the health budget, the area that suffered the most was the employment of new staff. Had the MDOH cut only the human resources, or had they proportionally cut here and there --like new equipment for a certain hospital or renovations of a certain clinic -- or was the focus just on employing new staff only?

Follow-up response

Dr Mohangi responded to the community service health workers follow-up question. The challenge they had was the budget cuts. If they had enough budget, they would be able to appoint all of them. Where they may have a medical officer grade 1 position that was available, they would advertise the post and all the community service workers had to compete because it would not be fair to absorb one in that particular hospital and not give the others an opportunity.

Contact details

She had added the contact details under the chat group, and provided the Committee with her cell number.

Case distribution per age group

The 10% were not necessarily all those who were hospitalised, but were those who were under 19 that had tested positive for COVID-19. Unfortunately, she did not have information as to whether it was located in a specific area or not.
Prosthetic and orthotics internships

The MDOH had about four interns at the moment. She did not know off hand the stipend they were being paid.

Budget cuts

The letter they had received from the Provincial Treasury indicating their budget for the next financial year showed that the budget cut had been done on COE, so they had not been requested to cut the budget further. It was based on a letter they had already received from Treasury on the allocation for next year, which showed a budget cut of R1.2 billion on COE alone.

Closing remarks

The Chairperson read over the information on which the Committee could possibly ask follow-up questions. He had received information on the various hospitals throughout the provinces that would be receiving vaccines that day, and if the Members had time they could go and visit the various hospitals to do oversight. 

Ms Gela seconded the proposal of having the meeting on Friday to approve the minutes.

Dr Thembekwayo asked whether it was possible to discuss Committee related matters outside the presence of the invited guests.

The Chairperson thanked the invited guests for giving their presentation, and confirmed the Committee would visit to do oversight. He thanked them for the work they had done, and dismissed them from the meeting.

He requested that in the future, if they were having a meeting at 9am, the Committee should deal with in-house matters and start at 8.30am before the arrival of the invited guests, or they could ask the invited guests to start their presentations at 9.30am. However, he was concerned the later time would interfere with their presentations.

The meeting was adjourned.