North West COVID-19 Update & Vaccine plan


24 February 2021


North West Department of Health: Management of Covid-19 

Meeting Summary

In this virtual meeting, the North West Provincial Department of Health (NWDoH) briefed the Committee on its health care services in relation to Covid-19 and its vaccine rollout plan. It reported that Covid-19 deaths in the province stood at 1 027, or 0.025% of the population, compared to the national average of 0.077%. With the onset of the second wave, deaths had increased sharply in the second week of January, but had started to decrease again during the third week. The NW had a case fatality rate of 1.6%, and as at 21 February it had 3 445 active cases.

The NWDoH currently had four challenges. These were contact tracing, the limited capacity of environmental health in municipalities, staffing for the vaccination programme and transport for persons to be vaccinated. The environmental health capacity had to be increased in the province and municipalities. If there was a third surge, bed availability and reticulated oxygen would be a challenge.

The Department had been under administration since 2018, and Members asked several questions about when this would end and what the exit strategy was. They were told the Administration period had been extended, as a Head of Department for Health had not been appointed and there were other areas that still had to be addressed, such as pharmaceutical services. The Administration’s exit would be reviewed in June 2021.

Members said that in order for the province to have stable leadership and function, it needed to get out of Administration.

Members asked about the emergency medical services (EMS) and ambulances in the province, staffing, health care facility readiness, preparations for a possible third wave, infrastructure, oxygen and Information Technology (IT). The Department assured them that it had multiple measures in place to address their concerns.

Meeting report

Opening remarks

The Chairperson said the meeting would begin with the presentation from the North West Provincial Department of Health. He asked the Department to run through the presentation quickly, as Members had already received the slides. He wanted to know from Mr Madoda Sambatha, Member of the Executive Council (MEC) how long the Department would remain under section 100 and how long Ms Jeanette Hunter, Deputy Director General in the National Department of Health (NDoH) would remain in North West.

He welcomed Members, the MEC and the North West Department of Health (NWDoH) leadership.

Health MEC’s opening remarks

MEC Sambatha said his team welcomed the invitation from the Committee, as oversight assisted it to understand its areas of weakness and improve service delivery. The NWDoH was under section 100 1b administration which meant that there was an Administration. He requested that the Administrator introduce the administration team and lead the presentation.

The Chairperson asked how long Ms Hunter would be in North West, as she had to be back in Pretoria where she was supposed to be working.

Ms Hunter greeted those present and introduced the team with her. She said she had hoped to be out in August 2020, and a roadmap for exiting had been developed which she and the MEC had signed for the Minister. However, at that stage the Inter-Ministerial Task Team (IMMT) led by Minister Nkosazana-Dlamini Zuma and the entire IMMT felt it was not ready, and a new date was given for March 2021. The team had met with the IMTT and the National Council of Provinces (NCOP) committee responsible for the administration a week ago,, where a Cabinet decision was endorsed which stated that the Administration was not ready to exit, and the exit would be reviewed in June.

The key reason for this was that the NWDoH’s Head of Department (HoD) had not been appointed, and this was the case in many other departments under administration in the province. This was not due to the Department not working hard to appoint an HoD. There was a recommendation made in February 2020 to the Premier, but the process did not go through for multiple reasons. Another submission had gone to the Premier where a candidate was recommended. There were still things that had to be done to ensure stability for pharmaceutical services, and a HoD had to be appointed. After these two matters were addressed, the Administration could exit. This would depend on the IMMT, the Cabinet and the NCOP.  

Ms S Gwarube (DA) proposed that follow up questions be allowed on the matter of the Administration before moving on.

The Chairperson asked if she could include the questions later on in the discussion.

Ms Gwarube said that the matter was different to the presentation topic, but she had no problem including her questions later on.

The Chairperson requested that the questions be included and discussed further during the discussion.

NWDoH presentation

Ms Hunter said the Department welcomed further advice and direction to improve. She would not dwell on the matters in the presentation.

She outlined the pillars of the North West’s Covid-19 strategy. The pillars had to be adhered to amidst a burden of disease, and normal health work had to continue while the pandemic was being managed. The success of the strategy depended on staff wellness.

Regarding discipline and consequence management, some staff had wanted to take advantage of the lockdown levels and work from home. Strict discipline had to be applied, as people had to be at work. It had received good governance through the National Command Council, the Provincial Command Council as well as District Command Councils in the province, and that had helped to implement the strategy.

The key data for Covid-19 statistics in North West (NW) were outlined, with the presentation updated to include the latest figures. The highest number of cases were in the Bojanala Platinum district, followed by Dr Kenneth Kaunda and Ngaka Modiri Molema district. The lowest was in the Dr Ruth Segomotsi Mompati district municipality. As at 23 February, the NW had a total of 60 335 Covid-19 cases.

She gave an indication of the province’s weekly increase/decrease in Covid-19 figures in comparison to the other provinces. In four districts in the province, and in the province itself, there was a downward trajectory for daily new cases. The current recovery rate was 92%, which was below the national recovery rate as it had its surge later than the other provinces.

The first surge in the province had been longer in duration, but did not have the same high numbers as the second surge. The second surge had ended within four weeks, and the high numbers had placed pressure on the hospitals.

Although there had been a decline in the country, Covid was not gone. With the upcoming Easter public holiday weekend, the country and its leadership had to take steps to prevent a third surge. There had to be continuous work in unison to flatten the curve, and citizens had to stay at home and adhere to the “red toolbox.”

On contact tracing, she said that considering the last six epidemiological weeks, the Province’s testing rate was still high but the positivity rate had come down.

Ms Hunter outlined the Covid-19 figures in the province relative to population size, and gave a comparison of the statistics against the other provinces. The Covid-19 deaths in the province stood at 1 027, or 0.025% of the population, compared to the national average of 0.077%.

The NW had a slightly higher number of males succumbing to Covid-19 than females. Deaths had increased sharply in the second week of January, but had started to decrease again during the third week of January. The NW had a case fatality rate of 1.6%, and as at 21 February it had 3 445 active cases and a 20.7% positivity rate.

On the staff related Covid-19 figures, she said that there was a death rate of 1.59% and 59 active cases.

The hospitalization curve was similar to the daily and weekly positive rate curve. Most people in people were in general wards, with small numbers in the Intensive Care Unit (ICU) and high care facilities, with very low numbers in the isolation wards. In week seven, there was a 40% decrease in hospital admissions from the previous week. The majority of the admissions were reported at the West Vaal hospital.

Regarding bed capacity, she said that for the second surge, the emergency medical services (EMS) had played an important role. The Administration had begun strengthening EMS in 2018. The province relied on these services, as it had started to feel bed pressures in hospitals such as Job Shimankana Tabane in Rustenburg. Dr Kenneth Kaunda had a lot of bed capacity, as there had been a donation from the mines there. It also had a relationship with the private sector, where there was the Duff Scott Hospital ready if needed, and extensive additions were made to the Klerksdorp Tshepong Hospital.

Ms Hunter said that as the country had beaten the extremely drug resistant tuberculosis (TB), the dedicated wing for it at the Tshepong Hospital had come in handy for managing beds for Covid-19. EMS was important for managing Covid-19. It was also seen that some districts did not have high numbers, and therefore resources could be leveraged from one to the other. The beds set up in the first surge were available for the second surge. The additional bed capacity was still useful, despite a decrease in cases, as it was used being used for the vaccination programme.

On equipment and staffing, she said that there was currently sufficient equipment, oxygen and ventilators. The province had not run into issues with staffing. When the Administration entered in 2018, there were a number of posts that had not been filled for years after staff had retired or died. There was a project where reticulated oxygen was being installed, as mobile oxygen was not ideal.

The three large hospitals -- Job Shimankana Tabane, Klerksdorp-Tshepong and Mahikeng -- were experiencing pressure with regard to shortages of staff. This was because some of the staff had contracted Covid-19 and had been off from work until they were well. The NWDoH continued to work with the Provincial Treasury to reprioritise available funds in order to appoint additional staff where needed. It also needed additional staff to make the vaccination programme succeed.

The NWDoH currently had four challenges. These were contact tracing, the limited capacity of environmental health in municipalities, staffing for the vaccination programme and transport for persons to be vaccinated. The environmental health capacity had to be increased in the province and municipalities.

If there was a third surge, bed availability and reticulated oxygen would be a challenge. For Human Resources (HR), there was no major challenge as there was a strong relationship with the Provincial Treasury, which was very responsive. There was a transport challenge, as contact tracers and community health workers had to get to communities. There had subsequently been agreements with local taxis, and matters were being attended to.

Ms Hunter said the NWDoH was doing very well in managing Covid-19 and it was off to a good start with its vaccination programme. A key reason for it doing well was the dedication of its frontline staff and managers, who were willing to multi-task and take problems in their stride. She commended the staff.

There was also good guidance from the NW Covid-19 Command Council, guided itself by the National Coronavirus Command Council (NCCC). A recommendation had been made to the Executive Committee (Exco) chairperson to say that District Command Councils had to continue after Covid-19, as they were a good forum for addressing social determinants of health. The Department had good cooperation with Provincial Treasury and sister departments (provincial and national), other provincial departments, the private sector, the non-governmental organisation (NGO) sector and academia. Due to being under Administration, consequence management was strong in the Department.

A number of donations had been received, such as a field hospital, beds and the Cuban Brigade from the NDoH. Personal protective equipment (PPE) donations had been received from the NDoH, mines and insurance companies. These donations had been given and received following Public Finance Management Act (PFMA) prescribed asset management procedures. She said that the Cuban Brigade had come at the right time, and were really an asset in the province.

The department had dealt with malice and fake news issues, and remained on the alert for such matters.

She outlined the current risks for the NW. There were risks such as cross border and inter- provincial travelling to hot-spot provinces, a rapid rise in infections being fuelled by so-called super spreader events such as family and social gatherings, music and cultural events. Social behaviour and excessive alcohol consumption was also driving up the number of trauma cases in the province’s hospitals.

Ms Hunter described the many lessons that had been learned by the NWDoH. The lessons from benchmarking the NW with the Eastern Cape and Western Cape were also outlined.

Vaccine roll out plan

To achieve population immunity, the target was to vaccinate 67% of the population, which was 2.7 million people. If it was not a single dose vaccination, the number of shots and work processes would double.

She outlined the nine pillars for the vaccine rollout plan.

The rollout would be done in phases, and phase one was characterised by a limited supply of vaccines, and therefore targeted those at highest risk for infection, focusing on frontline health care workers (HCWs). In the NW, the priority HCWs were health care professionals, non-professionals, support staff, private practitioners, traditional health practitioners and environmental health practitioners. The phase one vaccinations that had begun in February would continue for three months. Those in areas with high aerosol generation were also targeted for phase one, and this included administration staff and cleaners, not just HCWs.

The targets for phase two were essential workers in government departments, workers in the retail sector, the mines, the transport industry, big businesses and media, and members of legislatures and traditional authorities. Others to be vaccinated in this phase would be people older than 60, prison inmates, and those above 18 with other illnesses. This phase would last six months.

Phase three would cater for the rest of the population, and would also last six months.

She said in that SA, the vaccine was voluntary and therefore education and counselling was being done. If HCWs had opted not to be vaccinated initially but had changed their minds, they would still be offered a vaccine in later phases. There were not cut-offs for phases, as people could come back to get vaccinated if they had initially opted out.

On governance for the rollout programme, she said that the Department had made a proposal to Exco for a consultative platform. It had also made a proposal for a political steering committee. A Vaccine Roll-out Coordinating Team had to be established and be functional before the rollout commenced.  This had to be chaired by the Accounting Officer, which was Ms Hunter.

The Department was engaging with Treasury on the budget for the rollout programme, as it needed funding for additional staffing, pharmaceutical consumables, networking and computer hardware, transport of staff to and from vaccination sites, transport of vaccine from storage points to vaccination points (phase two), additional security features and communication, particularly payment for radio slots.

The NW province had a total of 40 vaccination sites, with 23 in the public sector and 17 in the private sector, and it would consider how it could increase the number of sites it had.

As at 23 February, the country had vaccinated about 26 064 people, with NW vaccinating 3 482. The NW had administered the third most vaccinations of the provinces. The figures would change, as provinces would receive vaccines in quantities relevant to their population size.

At Klerksdorp Tshepong Hospital, a total of 3 672 individuals were targeted for vaccinations, and 2 547 vouchers had been issued. However, 1 804 were redeemed, which was 71% of the target. For Job Shimankana Tabane Hospital, 2 149 individuals were invited for vaccinations, and 1 527 eConsents were completed. She said this was where the voluntary nature became apparent, as people could not be forced to join. Once individuals had completed the eConsent and been approved, a voucher was issued for a vaccination to take place. Out of the 1 526 individuals that had received vouchers, 1 118 vouchers had been redeemed, which was 73% of the target.

On the way forward for the NWDoH, Ms Hunter said it would continue with the implementation of the Covid-19 resurgence plans, with focused support and care of the front line health workers, education to strengthen adherence to the red tool box, the current strong focus on contact tracing, optimal management of sick persons in hospitals and the rollout of the vaccination programme.

The NWDoH recommended that the province’s Exco Lekgotla directs to the Department of Cooperative Governance and Traditional Affairs (COGTA) that a plan be developed to strengthen environmental health services at the municipal level, and that a framework be developed for converting current district Covid-19 Command Councils into a platform for managing the social determinants of health post Covid-19.


The Chairperson thanked Ms Hunter for the national overview that she gave in some sections of the presentation. He said that the NW was doing well on the vaccination rollout programme, but Mpumalanga was ahead.

Ms A Gela (ANC) said the province had received its share of Johnson & Johnson doses from the Aurum Institute for Health Research in Rustenberg. She asked for a detailed explanation of the institute’s involvement. Was it contracted by the NDoH or the South African Medical Research Council (SAMRC)? Was there a contractual agreement that governed the conduct of third parties, to ensure the integrity of the process?

What challenges of non-compliance did the province have? The issue of HCWs being exhausted was common in other provinces -- were there any complaints of fatigue, and what support would it give to workers?

What was its strategy for communication so that it reached everywhere considering the vast nature of the province, and what was the status of EMS in the province?

She wanted to know the relationship between the Department and organised labour in the province.

On the issue of staff shortages, she hoped Treasury would assist the province.

What was its preparation for the third wave, and what was the province’s relationship with the mines?

She was happy to hear the good story about the Cuban Brigade. She hoped the Department would address its challenges. She was pleased with the vaccine rollout strategy, and what was being done in this regard.

Ms E Wilson (DA) acknowledged the challenges the province had, and commended it for what it had done regarding Covid-19. She said that the appointment of an HoD was one of the biggest challenges, and was why the Administration was being prolonged. This must have had a serious impact on the management of Covid-19 and the vaccine rollout. Was she correct to say the province had received vaccines for only two hospitals and 3 900 doses? It was mentioned that there was a problem around the information technology (IT) sector. She asked for clarity on this, as the situation with IT was critical and had to be addressed.

She asked if measures had been in place to ensure there would be special attention to medical waste disposal.

On the potential third wave, she said that considering all the complaints about the ambulances and EMS facilities in the NW, this was an area that needed attention. Prior to the Administration, there had been concerns about a tender issued for ambulances. It appeared that the situation had not been resolved, and she requested an update on this matter.

On vaccinations, she said that there was variance between the number of vouchers issued versus the number redeemed. Why was this the case? Was it because the HCWs were far from hospitals where the vaccines were being administered? This was an area of concern, as HCWs could not be moved from one hospital to the other. The matter would have to be addressed going forward.

What vaccines would the NW receive and in what numbers?

Ms H Ismail (DA) asked when the forensic investigation into Buthelezi EMS and Hartbeespoort Emergency Medical Service (HEMS) be made available. She said that the issue dated back to 2016. and requested feedback on the matter.

She asked for a full report on the number of senior officials suspended in the Department.

On medical depot accruals, she said the outstanding arrears had to be addressed, and asked how far the Department was in addressing the arrears. What was the accrual amount at the beginning of the intervention, if there were any interventions?  She was specifically asking about the medicine depot.

On infrastructure, she asked for a progress report on the three health care facilities being built. Who had received the contracts to build the clinics, and how much did each clinic cost?

On vaccinations, and those prioritised for the different phases, she asked when frail care workers would be considered to access vaccines. She mentioned the case of a frail care worker who had tried to get on the system but had not been allowed.

She asked if there was a deficit between the status of HCWs and established posts, and requested a report on the categories and posts to be filled.

How many interns and community service doctors had been placed? Had they had been paid, and was the Department considering integrating them into the system?

She asked for a report on how the province’s mortuaries were coping.

Ms N Chirwa (EFF) said that the province had limited public transport. She requested a detailed breakdown on EMS in the province. She was interested in their distribution in the rural areas versus the urban areas.

She asked for details on infrastructure so that there could be detailed follow ups. How many health facilities needed urgent refurbishment and infrastructural intervention? How would infrastructure challenges affect mass vaccinations? The state of readiness had to go beyond fridges and storage, and consider factors such as whether there was seating for those getting vaccinated and overburdening health facilities. She could think of facilities that could not handle mass vaccinations if it were to happen in April. She appreciated the presentation, but requested less vague information. She wanted a detailed breakdown of health facilities that had issues, and what the interventions had been.

She said the health facilities had collapsed in Taung. Where were the vaccination sites in Taung?  

Ms Gwarube said that in order for the province to have stable leadership and function, it needed to get out of Administration. It was unsustainable, and she wanted to know the way forward. The province could not be governed under administration in perpetuity. There had to be urgency to address the situation, as there had to be individuals who could be held accountable.  She asked for clarity on what the way forward on the matter was, and the possible timelines for stable leadership in the province.

On readiness for the mass vaccine rollout, she asked if the province was confident that primary health care facilities identified as distribution sites were ready to be nodes for the communities that they were in.

Mr M Sokatsha (ANC) asked Ms Hunter to elaborate on the province’s communication strategy. On ambulances, he asked how many individuals an ambulance crew consisted of.

Dr S Thembekwayo (EFF) said that Ms Hunter had mentioned that staff were taking advantage, and that there had been strict discipline. The use of the term “taking advantage” indicated to her that the staff did not have a platform to say that that they were unwell due to the way the province was being administered. There should be mechanisms in place for addressing psychological problems the staff had, but the manner in which the province was being administered, the staff were afraid to come forward as they were not given a chance. She felt that Ms Hunter had stayed in the province for too long, and the sooner she went back to the NDoH the better, in order for the province to run its own affairs effectively without her interference.

Nothing had been said about the involvement of traditional healers in this process. There was an allegation that traditional healers were once invited to a meeting, but they had been left out and therefore were not at the first important meeting. Why were traditional healers not taken into consideration in the province, and who was preventing this?

She asked if Ms Hunter had anyone related to her or others in the province in health-related matters that had secured contracts for Covid-19-related procurement. She requested that if this was the case, the Committee had to be informed before the media pounced on the province. The Committee had to be informed if there was a discovery of a fraudulent middle man in the contracts.  

It was important for staffing to be done correctly, and the Department was waiting for the appointment of the HoD as soon as possible. The province had been under administration for a long time and as soon as it exited the better.

Ms M Hlengwa (ANC) said Ms Hunter had not been presenting on the NWDoH, as she had touched on all the other provinces and had made comparisons. She said this was wrong, as the Committee had been waiting for a report from the province.

Sshe asked if there were measures in place to overcome shortages of oxygen and infrastructure challenges.

She said NW province had very high temperatures and the vaccines needed to be kept cool. Considering this, were there measures to control temperatures when the vaccines were being transported?

The Chairperson requested a letter regarding the appointment of a HoD from the MEC. He said that the systems did not allow Ms Hunter to leave. A letter detailing these matters had to be provided so that the Minister could be engaged. Ms Hunter had work at the NDoH that had to be done as well. He wanted to hear the MEC’s comment, which should be followed up with a letter as well.

He asked for more information on the district command council being effective.

The presentation had mentioned that additional staff were required for vaccinations -- was this for phase one, or for the subsequent phases?

He asked for further information on where the information those who had been vaccinated was coming from, and where one could find this information.

Did the Department have challenges regarding back-up fridges and generators, considering that the vaccine was temperature sensitive?

What value had the Cuban Brigade added to the province?

Was there a figure for the number of staff members being reluctant to get vaccinations?

He said that he had heard that there was a possibility that someone could be given a vaccination shot of one brand, but a booster shot of a different brand. He asked for additional information if possible.

Mr Madoda Sambatha, Health MEC, said he would respond to issues as requested, but asked that the Administrator and team answer on technical matters first.

Administrator’s response

Ms Hunter responded on the involvement of the Aurum Institute for Health Research, and said that the conditions under which the Johnson & Johnson vaccines for phase one were received were research conditions. It was called phase 3b research, whereby the vaccine was declared safe by previous research as well as efficacious, but more information was still required. The country had been ready to start its rollout with AstraZeneca, but then it was discovered that this vaccine was not efficacious for the new variant in SA. It had then been abandoned for South African purposes and alternative purposes were found for it, but she did not have the specific information on this.

The research project belonged to the Medical Research Council of SA, headed by Prof Glenda Gray. Research organisations like Sisonke and Aurum had been contracted to work with the SAMRC. It was a national process driven by the SAMRC and Aurum and other research organisations. There was no relationship between the province and the SAMRC, so there had not been one with the Aurum Research Institute. The vaccines had gone from the national department to the research facilities, where it was then distributed to the two sites for the NW. There were physically three sites -- Klerksdorp Hospital and Tsepong Hospital, which was a complex but seen as one hospital -- and the Job Shimankana Hospital. 

Regarding exhausted HCWs, she said the province was fortunate as there had been a drive to fill vacancies since 2018. When the section 100 1b came into the province, there was an overall vacancy rate of 20%, which had since been lowered to the current 14%.

She and the MEC had visited all the public vaccination sites except for the one in Mathibestad, which it was going to visit that day but could not because of the Committee meeting.  During the visits, the readiness of the sites were checked against national prescripts, and this included the waiting space. The province wanted to meet the vaccinators in person. Based on this, she reported that the staff were in high spirits and had been taking leave and had received time to recover from sickness. A large number of social workers and psychologists had been appointed to assist staff.

She had used the words “take advantage” as it was bona fide English. Some staff had taken advantage of the general regulations passed on lockdown levels. Health department staff in specific areas did not qualify to work from home, such as office-bound staff. People needed to be at work, as the State Information Technology Agency (SITA) networks could not be accessed at home -- only in government buildings. There had to be action against staff who wanted to follow generic lockdown levels, and this had been done within the confines of the labour laws of the country. A health system could not collapse due to staff wanting to practice dereliction when it came to their duties.

She said there was an excellent communication strategy being driven from the Premier’s office. There was also constant communication, such as TV appearances and radio, in newspaper segments and the use of loud hailers, amongst others.

Based on her visits, and those of the MEC, staff were in high spirits. However, there was still concern about there being adequate staff numbers for phase two onwards.

She said people in care homes would fall under the category of those over 60, and those with co-morbidities, and there would be outreach to the centres.

There was a healthy relationship with organised labour, with healthy tension. She outlined the roles of organised labour and the province. The NWDoH had a unique history, because when the section 100 1b entered in May 2018, a large number of workers were agitating in front of government buildings, and there had to be several meetings with organised labour. An agreement was later signed on 19 May 2018 that workers had to return to work. There were elements who viewed the Administration as an instrument for their own means. The Administration did not allow this, but some had attempted to do this under the guise of the union. By sticking to its guns and applying consequence management and discipline, it had the unions admit that their members were not in line, and they were expelled. The matter continued in the NW, as some workers tried to agitate bigger groupings of workers to show dissatisfaction.

There was constant preparation for the third wave, but she hoped this wave would not arrive if the protocols were followed and the vaccines were administered. If the wave could not be avoided, the hospitals would be able to manage it to a certain extent, but if the numbers sky-rocketed, there would not be enough beds, staff or oxygen, as the funds were limited.

In response to the Chairperson, she said that about 3 900 dosages had been received.

On vouchers for vaccinations, she said that there was a discrepancy between those given approval versus those redeemed vouchers because the Johnson & Johnson vaccine was currently being administered under a research protocol. Due to this, the hospitals chosen throughout the country had to be close to the research institutes, as vaccines had been delivered there. The staff then had to come to these hospitals and appointments were made. It was likely that those approved were still waiting for their appointments. For example private general practitioners were allocated Sundays to receive vaccinations. She was hoping that there would be vaccines that could be administered ordinarily outside of research protocol, and then vaccinations would be able to go to all the sites. This would also likely reduce the discrepancy between those who received permission and those who redeemed their vouchers.

The key challenges on IT were networking and hardware in the NWDoH. It was sad that it was still struggling with network challenges in 2021. It was a neglected area in the Department, and IT took a back seat when the administration took over in 2018, as there were other priorities. The software from the national Department was the Electronic Vaccination Data System (EVDS), and it was working well. She said Mr Jannie de Beer, HR Resource Information Systems Manager, NWDoH, would comment or include how Members could access the software in the written response to questions. She said the data process was very important for epidemiological reasons and research, but also for the Auditor General’s (AG’s) purposes.

The Department had not had waste disposal problems since 2018. As part of their training, vaccinators had been taught to break vials, and there was proper disposal of the vials and needles.

Ms Hunter said the information on EMS facilities would be given in a written form. They fell short compared to the national norms for numbers, but there had been an improvement since 2018. A large number of EMS response vehicles had been purchased and transport vehicles had been bought as well. The province did not, however, have what was required in relation to national norms. When alcohol was banned, then EMS vehicles were freed from attending to violence and accident-related callouts and could therefore cope better. When there was a high level of interpersonal violence and accidents, the EMS could not attend to other priorities. A report would be given on EMS against norms for staffing and crew, as well the distribution of vehicles across the districts. She said they did not have single-man ambulance crews any more.

She said the Buthelezi EMS investigation was with the Hawks, but in 2018 the Administration had stopped all payments to Buthelezi as it had been overpaid, and then there was a reconciliation process. It had reached a stage where the Department owed Buthelezi, and there was an order from the South African Revenue Service (SARS) that a large portion of the money owed to Buthelezi had to be paid to SARS. The NWDoH did not have a relationship with Buthelezi and High Care any more, and these cases were with the Hawks. The details of the Hawks dealing with the matter could be provided. She added that the Department did, however, still contract private EMS when necessary.

The province did not know when and what vaccines it would receive next.

She asked if a report could be provided on the number of people under suspension, and the reasons why.

Medical depot accruals amounted to under R500 million, as total accruals were just under R1 billion. Unless additional funds were acquired, the accrual would remain as it could not deny the people of NW medication. There were negotiations on repayments, and suppliers continued to provide medication, but it would remain a cycle until the budget shortfall was addressed. The NWDoH had worked well with its Covid-19 budget in phase 1, and had an agreement with Treasury through the Exco that the Department could use that money to address accruals, but then second surge had come and the money was no longer available to pay accruals.

She asked for more clarity on names of clinics Ms Ismail had asked about so that the information could be provided in the report.

More information could also be provided on vacancies, but the vacancy rate had decreased since 2018.

On interns and community service, she said that the province prioritised these professionals and made sure it had funding to employ and train these individuals. It did not have money to absorb the professionals yearly, as its budget had shrunk for the next three years and the cuts would come from the compensation of employees (CoE). When people in other fields qualified, they were not guaranteed a job, and it made sense that health departments could not continually employ people.

A report on mortuary services would be provided, and a detailed report on infrastructure and what had to be done to address issues in facilities, would be made available.

Regarding vaccine readiness, she and the MEC had personally visited sites. There were two sites not up to standard, which were two hospitals -- Ganyesa and Lehurutshe -- but these facilities were getting assistance.

The Department had a good relationship with traditional healers. There was special directorate, called the directorate for special programmes, that traditional healers formed part of. The traditional healer representative had received a letter from the MEC to be part of the Covid-19 vaccine rollout coordinating committee. These meetings were done virtually, and there were attendance records as well as recordings. There were no persons appointed by the MEC to be part of the committee who had been excluded from any meeting. It had also been communicated where traditional healers fell in regard to the prioritisation phases for the vaccinations.

There was an active project to get reticulated oxygen into hospitals. It had never been short of oxygen, but cylinder oxygen was not ideal.

Information on the District Command Council would be included in report. It was chaired by the executive mayor of largest municipality in the health district. She was in awe of how well these meetings were run, and how departments were cooperating.

She said that more vaccinators would be needed for the subsequent phases.

She and MEC Sambatha had visited sites and evaluated vaccination sites. There were checks on fridges and if there were backup generators. 

She said that she had no information on future vaccines. She asked if Mr De Beer could comment.

Mr De Beer said that currently the Electronic Vaccine Data System was administered by the NDoH, and access to it was given to only one person per province. There would be engagement with national on how the information could be distributed further, and even perhaps included on a dashboard on the NDoH’s website.

MEC’s response

MEC Sambatha said the section 100 1b Administration was managed and coordinated by the IMTT on behalf of the national Cabinet, and then supervised by the NCOP. There was currently a session between the Administration, the IMTT and the provincial Exco. During this, the Administration had indicated milestones in terms of successes and challenges, and had presented areas that were still pending to be finalised with an exit plan. In the last discussion, it had been determined that departments under section 100 1b would be upgraded, based on their performance, to 100 1a and therefore be managed differently. However, when assessments were done and presented to the NCOP, it had concluded that there were pending elements, such as the appointment of the HoD.

The issues of the correcting the budget base line and the budget for pharmaceutical services were important. Having a HoD would not solve the NWDoH’s issues alone, as it was underfunded on pharmaceuticals, and this led to accruals. The issues pending were the appointment of the HoD, correcting the pharmaceutical budget, and correcting the budget baseline as well. 

He said someone who had said that the Administrator had overstayed her welcome, did not know the reality. The reality in the NWDoH was that if there had been no administration, the Department would have collapsed. One district, Ngaka Modiri Molema, had collapsed and had hospitals run by the Defence Force. This had been addressed, and everything required to have a proper and running department was in place. Whoever had said that the administration had overstayed were people that were hell bent on imposing anarchy and looting resources.

He said that he would give an example on this.

Dr Thembekwayo interjected to raise a point of order, and said that she was not “someone,” but “the Honourable Dr Thembekwayo.”

MEC Sambatha said he was not referring to Dr Thembekwayo as “someone”.

Dr Thembekwayo said she had presented the problem, and did not want to be generalised.

MEC Sambatha apologised.

He continued, saying that a practical example was that a contractor had been appointed and paid fees in advance.

The Administration would be determined by the Cabinet. There was a three-month extension, and the NW had five departments under section 100 1b and five departments under section 100 1a. For now, the Department was guided by the three-month extension.

On the students sent to study in Cuba, the value was in the attitude and character of the doctors that had returned. The Cuban programme was helping SA on the basis that Cuban-trained doctors added value to reengineering of primary health care. The doctors here for Covid-19 had taken a hands-on approach to solving challenges.  

He said that Ms Wilson and Ms Chirwa were correct on ambulances services distribution, and the proper distribution of ambulances. Each time ambulances were purchased, there was an added design to deal with rural terrain. This element had started being testing in Piet Plessis, and in the next batch of ambulances this element would be added. The Department was currently considering the best option between purchasing versus leasing ambulances. As the majority of the ambulances covered more than 100 000 kms, leasing appeared to be the better option. Leasing had benefits such as replacements when vehicles were being serviced or had broken down.

He said the Administrator had said that there would be a report on suspensions, staffing, vacancies and infrastructure.

For mass vaccinations, most sites had registered on the basis of static and outreach venues, but from phase 2 there would be decentralisation on the basis that the site had already been registered for outreach processes.

In response to Ms Chirwa’s enquiry regarding where vaccinations would take place, he said that it was currently Taung hospital, and for the second and third phase Sekhing would be used. The Department was working well to ensure that there was an intervention in Taung concerning infrastructure. There were other worse-off facilities, but the province was securing alternative building material so that these facilities had proper structures.

Comments that traditional health practitioners had been sidelined were not true, as there had been four consultative process where there was engagement. These practitioners were covered under phase 1.

He said that he was in Job Shimankana Tabane to observe how it was improving in the process of vaccination in the area, but was also observing the process of development of ward one, which provided 16 extra beds and three ICUs. He was observing development and progress in the EMS area, which was the reason for overcrowding. He was also checking the gateway clinic challenges. Infrastructure projects ensuredthat the province was ready for the NHI.  

The Minister had confirmed that the next batch of vaccines was 80 000 from Johnson & Johnson, and then this would be repeated in another two weeks. Investigations had to be done scientifically to determine if more than one brand of vaccine could be used on one individual when two-dose vaccines were involved.

The Chairperson said that Ms Hunter had requested names of clinics mentioned by Ms Ismail.

Ms Ismail responded that the three healthcare centres were those in Sekhing, Jouberton and Mathibestad. She wanted a full report on these three centres and how much had been spent, and if they were being used.

The Chairperson said that it would be a follow up question. Ms Hunter said it had been noted.

Dr Thembekwayo asked for a working contact number for someone who could be called for emergency responses.

To the MEC, she said that it was Member of Parliament (MPs) who were on the platform, and to be called “someone” was degrading, as it was she who had posed the question. It was unacceptable to be addressed as “someone,” and she did not take it lightly.

The Chairperson said that maybe the MEC could have put things differently, as the discussion was in public.

The MEC said he had not meant to be disrespectful to Dr Thembekwayo, and apologised.

Ms Hunter said that the number of the chief of staff in the MEC’s office, Mr Khumalo Molefe, was 0845784121.

The MEC said Members could Whatsapp him directly on 0721985433, and he would handle the matter for proper responses. There was a provincial Whatsapp group for the Portfolio Committee that enhanced communication as well.

The Chairperson asked the NWDoH to continue its work.

Adoption and consideration of minutes

The Chairperson asked the Committee Secretary to take Members through the minutes.

Ms Vuyokazi Mjalamba, Committee Secretary, said that there were four sets of minutes. The first set for 5 February, and had been deferred to this meeting from Friday last week.

The Chairperson asked if this was the one where the Minister’s input had to be checked.

Ms Majalamba confirmed this, and said she had checked the recording and the Minister had included safety, efficacy and availability. This, and the issue of the pricing, had been included in the minutes.

Ms Gela moved for the adoption of the minutes, and was seconded by Mr Sokatsha.

The second set of minutes was for 10 February, which were related to the briefing by Minister.

Ms Mjalamba said that issues relating to research availability and the two vaccines from China had to be included, and this had been done.

Ms Ismail asked if there was not a query on the Sputnik vaccine as well.

Ms Majalamba said it was not at this meeting, as she had listened to the recording -- it was Sinopharm. Perhaps the issue of the other vaccine had come up in another meeting.

Ms Ismail said that this meant that one of the other meetings had not been clarified properly. Another issue was if private medical aids could procure vaccines themselves. She was not sure what minutes this issue belonged to, but it meant that minutes were not correct if it was not in this one.

Ms Majalamba said that she was not sure what Ms Ismail was referring to. She had summarised the questions, but there was a recording with specific questions asked. She said the questions were clustered when multiple people asked a similar question, but otherwise it was covered in the recordings.

Dr Thembekwayo said that there had to be trust in the Secretary.

The Chairperson supported Dr Thembekwayo, and said the Secretary was not expected to record every single word. He had also asked about Sputnik as well, and perhaps things would be corrected going forward, as every time the Committee sat the previous minutes would be endorsed.

Ms Gela moved for the adoption of the minutes of 10 February with corrections, and was seconded by Ms Hlengwa.

The third set of minutes was for the briefing by Mpumalanga on 17 February. Mr Sokatsha moved for the adoption of the minutes, and was seconded by Ms Gela.

Ms Majalamba said that the last set of minutes were for 19 February, where multiple minutes were adopted.

The Chairperson said there were about 26 sets of minutes. The minutes for 5 and 10 February had been outstanding, and were brought for consideration that day. The Committee had resolved to meet with the South African Health Products Regulatory Authority (SAHPRA) on a regular basis once a month, and with the Minister fortnightly.

Ms Wilson said initially it had discussed SAHPRA coming every two weeks and a minimum of once a month at least. This had been the final decision of the Committee.

The Chairperson said it was once a month for SAHPRA, and fortnightly for the Minister.

Ms Gela moved for the adoption of the minutes, and was seconded by Ms Hlengwa.

The Chairperson requested that the fortnightly meetings with the Minister not be scheduled for Wednesdays, but if they were, they must not block other work the Committee had. He would check before making a firm proposal to the Minister. He asked Members to comment.

Ms Ismail agreed, as long as it did not affect plenary sittings. Members would not want to squeeze everything into one meeting where there was not enough time for everything.

Ms Gela supported the Chairperson’s proposal, and asked why the DA and EFF did not approve minutes and why they were quiet when it came to minutes.

Ms Wilson said that it often transpired that the ANC approved minutes in seconds, while others were still going through the minutes. If there was a disagreement, it would be raised.

Dr Thembekwayo said Members had a right to say or not say something in the meeting.

Ms Ismail asked for feedback regarding correspondence that she had sent requesting a meeting with the Internship and Community Service Programme (ICSP) and the Health Professions Council of South Africa (HSPCA). When would the Committee be engaging with these entities?

The Chairperson said he would follow up with Ms Majalamba on the matter.

The Chairperson asked if Members wanted to raise any other issues. He had tried to make a follow-up with House Chair regarding a meeting, but he would come back to Members on the matter.

The meeting was adjourned.