ATC140404: Report of the Portfolio Committee on Health on the oversight visit to the North West Province from 29 July to 2 August 2013, dated 12 March 2014
Report of the
Portfolio Committee on Health on the oversight visit to the North West Province
from 29 July to 2 August 2013, dated 12 March 2014
Committee on Health (the Committee) having undertaken an oversight visit to the
North West Province from 29 July - 9 August 2013 reports as follows:
One of the functions of the Portfolio Committee on Health
is to conduct oversight over executive organs of state in the national sphere
of government under its portfolio in order to monitor the fiscal and
programmatic integrity of health programmes; to ensure that funding of these
programmes is being provided properly; to safeguard health care quality; and to
ensure compliance with legislation, regulations, and other administrative
requirements applicable to health care delivery. The Committee therefore
conducted its oversight visit in various health institutions in the North West Province
from the 29 July to 2 August 2013.
The purpose of the visit was to assess health care
delivery, with special emphasis on quality of health services, infection
prevention and control, the referral system, functioning of the primary health
care system, roll out of ARVs and drug availability, achievements and
challenges with regard to the roll out of the National Health Insurance Pilot
The visit also aimed at gaining
insight into the functioning and recruitment of retired nurses, how they are
compensated and their scope of work.
The delegation comprised of the following Members of
Dr MB Goqwana (Chairperson of the Committee and leader of
the delegation - ANC); Ms MC Dube (ANC); Ms TE Kenye (ANC); Ms RM Motsepe
Ms M Segale-Diswai (ANC);
Kopane (DA); Ms D Robinson (DA); Mr D Kganare (COPE); and Ms H Msweli (IFP).
The following officials accompanied the delegation:
Ms Vuyokazi Majalamba (Committee
Secretary); Ms Nombali Magubane (Committee Assistant); Mr Zubair Rahim (Committee
Researcher); and Ms Lindokuhle Ngomane (Content Advisor).
visited the following public health facilities:
Job Shimankana Tabane Hospital, Boitekong Community
Health Centre, Moses Kotane Hospital, Pella Community Health Centre, Mafikeng
Hospital, Lehurutshe Zeereust Hospital Complex, Klerksdorp/Tsepong Hospital
Complex, Tsepong MDR Hospital and Witrand Psychiatric Hospital
Oversight visit to different
Job Shimankana Tabane
Delegation at the hospital:
Dr B Moagi (Senior Clinical Manager and Acting Chief
Executive Officer); Mrs EB Mogondsi (Deputy Director Quality Assurance); Mrs R
Diphoko (Nursing Service Manager); Mr MT Khoygoana (Deputy Director Corporate
Services); Ms M Rakau (Chief Director); Dr F Reichel (Director HOD Support);
and Ms R Lobeko (Media and Communication).
Dr Moagi led the delegation and tendered an apology for
the CEO who could not be present due to other engagements.
Dr Moagi welcomed the delegation and made a
presentation focusing on the background of the hospital; services rendered;
progress on the six ministerial priority areas; and highlighted their successes
and challenges. Job Shimankana Tabane (JST) Hospital is a level two provincial
(regional) hospital in the Bojanala District in the North West Province. The
hospital was founded in 1923 by the Rustenburg Rate Payers Association and the
first building was completed in 1927 and named Paul Kruger Hospital.
In 1997, the hospital was configured a
regional hospital and named Rustenburg Provincial Hospital. In 2008 it was
re-named Job Shimankana Tabane Hospital.
Dr Moagi went on to say that Job Shimankana Tabane was an activitst and
he hailed from the Maile Village, 35 kilometres outside Rustenburg.
The Maile village is part of the cluster of
Batswana ba Phokeng villages that are under the Royal Bafokeng Administration.
Rustenburgs economy is led by mining activity and the
greater part of its population is rural and is influenced by migrant labour
system from all over Southern Africa.
The hospital serves as a referral hospital to four of the five sub
districts, especially the Swartruggens/Koster, Brits and Moses Kotane District
The hospital has 396 approved beds and 316 usable beds,
14 neonatal Intensive Care Unit (ICU) beds, six adult ICU beds, 30 beds in the
accident and emergency department.
beds were reduced because of the unsafe building and a 20 bedded ward was
converted to a dialysis unit.
Bojanala district comprises of the following
sub-districts and facilities:
which has no hospital and no community health centre;
district with a hospital that is under construction and two community
which has no district hospital and three community health centres;
Kotane which has Moses Kotane district hospital and two community health
Swartruggens which has Koster district hospital complex.
Services provided at the
Accident and emergency services including family
medicine, Obstetrics and Gynaecology, reproductive health and Choice on
Termination of Pregnancy (CTOP) services, Paediatrics, Neonatology, Internal
Medicine, HIV and AIDS wellness clinic, General Surgery, Orthopaedic, Mental
Health, Anaesthesia, adult ICU, Neonatal ICU, Radiology serviced including CT
scan, Ophthalmology, Renal Services and Complex Orthopaedic like Joint
Allied health services provided are speech therapy and
audiology, occupational therapy, physiotherapy, radiography, social worker
services, psychology services, dietetics services and pharmaceutical
Services provided within the hospital premises but not by
the hospital are dental, emergency medical rescue, pathology which is provided
by the National Health Laboratory Services (NHLS), South African National Blood
Services (SANBS), Forensic pathology and Road Accident Fund.
Highlights of the hospital include a state of the art
renal unit which was officially unveiled on the 27 February 2012; refurbished outpatient
department, refurbished accident and emergency admissions, and treatment areas
and the resuscitation ward.
Projects that were unfolding were medical ward, surgical
ward, mental health ward, ICU and revamping of the theatre.
Projects that were cancelled due to budgetary
constraints were maternity obstetric unit, dedicated unit for mother and child
services, as well as Boitekong Health Centre extensions to improve maternity
Dr Moagi provided the committee with a report on a
planned provincial tertiary hospital, the business cases for a new hospital in
keeping with August 2011 Gazette that states that the North West Province should
have provincial tertiary hospitals in Rustenburg and Klerksdorp.
Progress report in relation
to the six ministerial priorities
infrastructure is old, however the hospital is clean.
The hospital participated in a
adjudication was conducted but still
waiting for results.
equipment and cleaning materials have been procured.
on cleaning and policies were offered to cleaners and operational
out of stock from central depot were bought out of contract. Cleanest
competitions are held weekly with all sectional managers.
Two peer reviews on cleanliness were
for patients blankets and gowns were received in June 2013.
The Hospital received a compliment in
the June article of the local newspaper on cleanliness.
Infection prevention and
recorded at 1.2%.
is a dedicated infection prevention and control coordinator and a training
plan on universal precautions is currently being drafted for patients,
staff and public.
PPEs in stock, contingency plan were in place for those not in stock from
Supply Chain Management and Mmabatho depot and extra stock from other
units was evenly distributed or to those units in need.
clothing for general workers and clinical staff were ordered and those for
general workers were received in June 2013.
staff assessment for National Core Standards (NCS) was done by managers.
Positive and caring
attitude remained a challenge though it had improved.
of managers and personnel on Batho Pele Principles and change management
strategies to improve attitude were unfolding like forming task teams and
plans were in place for their analysis.
was given to staff through monthly meetings and quarterly mass meetings
including other scheduled meetings.
were managed and resolved according to the complaints management policy by
sectional complaints managers and quality assurance.
of staff misconduct are reported, code of conduct and policy signed,
distributed to all departments for staff to sign.
Patient safety and security
fencing was changed in 2011 from pourous mesh fence wall.
This reduced the number of entrances and
security remained a risk following challenges of the supplier with the
South African Revenue Services (SARS).
of health professionals from different disciplines including other
categories on NCS and six priority areas was provided.
self assessment using the core standards questionnaires was conducted
quarterly to assess standard adherence from clinical and non clinical
mortality and morbidity meetings in medical disciplines, patient safety
group (PSG) and pharmaceutics and therapeutics committee (PTC) meetings
checking of critical equipment by different units to ensure functionality
and maintenance was done according to maintenance plan by health
Kaizen Model which won international award for reducing patient waiting
times was rolled out to different units. Reports on waiting time was measured
and submitted to quality assurance and the average for June 2013 was 172
and sorting of patients in outpatient department (OPD) were done daily to
improve waiting times.
training of personnel on NCS and ministerial directives to address the
waiting time in all units will be conducted.
Availability of medicines
hospital was at 91-94% during the time of the visit.
ordering and delivery of medicine, back orders were received monthly.
the ARV and TB treatment were at 100% available.
condoms were distributed to JST outlets and there was no shortage
The following challenges were reported on drug
August 2012 the hospital was at 76% due to suppliers being unable to meet
was a gap between the new and the old contractor as the new contractor was
given 90 days to deliver and yet the old one had expired.
NWP medical depot system was also not functioning properly.
Mother and Child Health
mother and child health services is
led by: one
full time obstetrician and gynaecologist and four part time specialists;
team of midwives and advanced midwives; and trained neonatal ICU nurses.
four district hospitals and numerous clinics
complicated obstetric patients to JSTH for definitive management.
neonates were managed at JSTH.
average approximately 420 deliveries per month are managed at JSTH.
average, there were 30 and 46 admissions in neonatal ICU and neonatal ward,
The following challenges
infrastructural resources at JSTH has
not grown with the growing city and population it serves.
A remedial action is a new hospital in
Rustenburg to serve as a level two whilst existing hospital becomes level
is no level one hospital in the Rustenburg sub-district.
An addition of a 24 hr Community Health Centre
needs to be established in the city.
Primary Health Care and level one
need to be strengthened so that they can provide adequate package of
is no access to tertiary hospital in NWP, referrals to Gauteng Province
tertiary hospitals is very difficulty especially Dr George Mukhari
Hospital and Steve Biko Academic Hospital.
Gauteng Province and the tertiary hospitals have a contract with NDOH
that as beneficiaries of the National Tertiary Services Grant they are to
provide listed tertiary services.
More than R2.3 million has been allocated to the hospital for this
Dr Moagi noted that this
information may not be known to the clinicians and specialists who are
denying patients this access and perhaps administrators with this
information should ensure that it filters to all clinicians and that all
is poor antenatal clinic attendance or care which leads to complications
later in pregnancy.
Many come to
Bojanala because of their partners or husbands who work in mines and they
would not have had any antenatal clinic from where they come from.
A remedial action is to strengthen Basic
Antenatal Care (BANC) training and practices.
Training has occurred at PHC but
implementation is poor.
challenge is the number of illegal unsafe abortions which leads to the
high maternal death rate.
compounded by insufficient service points providing for the service.
To remedy this challenge the hospital
will increase service points providing safe abortions and therefore
The inequality in
resource allocation in the NWPDOH was also noted as a challenge.
The less densely populated districts
have better human and budgetary resources and the more populous Bojanala
district was less resourced with poor health outcomes.
Theres a need for a revision of
resource allocation model like infrastructure development for cancelled
projects and equitable allocation of persal post.
Having concluded the briefing, the delegation went on a
walkabout in the hospital and visited the following wards:
The ward was a six bedded unit and Sister Distele
informed the delegation that they had bed shortages and when the ward is full
they have to extend to other wards.
There were bed shortages and had to extend to other wards
Staff shortages were also
prominent in the ward, with three midwives and two nurses per shift of four
Space shortages were also highlighted in the labour
This was illustrated by the fact
that the high care, labour unit and the antenatal unit were in the same
There was only one oxygen machine
which services the six beds instead of each bed having its own oxygen supply.
There was no security gates at the emergency unit and
people can just walk to the unit from outside, this presents safety concerns
The renal unit used to be a female surgery.
The unit is well equipped.
They use guidelines from the South African
Renal Association as well National Guidelines.
Boitekong Community Health
Delegation at the Community Health Centre:
Ms E Moladisi
Manager Nursing); Ms ME Rakau
Office); Ms R Moseneke
Mr L Tlhowe
(Rustenburg Sub-district Manager);
Ms J Thuppe
and Ms R Lebeko
(Media and Communication).
Ms Moladisi informed the delegation that Rustenburg sub-district
is the largest of the five sub districts in Bojanala with an estimated
population of 549 775 according to 2011 census.
It has a total of 22 facilities including the
then local municipality clinics which are four.
The facilities are clustered in three namely Thibane, Bafokeng and
a total of 10 PHC mobile clinics (including Rustenburg Platinum Mine and Royal
Bafokeng Administration) and one dental mobile clinic.
Boitekong cluster constitute 40% of the
population of Rustenburg sub-district.
Services rendered are PHC, Maternal, Child and Womens Health
(MCWH), reproductive health, communicable diseases (TB, HIV/AIDS and ART), emergency
services, immunisation, mental health, male medical circumcision and oral
Ms Moladisi noted that the workload for the CHC is heavy
based on the complexity of conditions
waiting times is prolonged with an average of 5-6 hours against the norm of 3
hours. To minimise this workload and reduce waiting times the following strategies
chronic patients are given two months supply of medication.
total headcount which seems to go down as compared to the expenditure on
system is intensified.
for booked patients are drawn a day before the appointment day and the
challenge is during weekends when clerks are not available.
queues for specific types of patients.
The following challenges were noted:
is no separate staff for maternity and emergencies/casualties as informed
by statistics. The CHC experienced large numbers of these types of
is no support
like cleaners and clerks
Nurses retrieve files
and wipe the floors when these categories are not available. This has a
direct impact on waiting time and infection control.
speciality staff such as midwives, trauma trained etc.
is no doctor on call after hours.
is inadequate budget to fill the posts and convert some existing posts to
address staff shortages.
equipment is not enough in numbers for the clinicians and not
are not enough security guards and are not equipped (not armed) for the
types of risks in the area.
are delays in attending to maintenance needs.
is no artisan on site to attend to minor maintenance work.
are challenges with public works.
equipment repairs are done by technicians in JST Hospital.
is inadequate space
is only one waiting area for clients including children which compromise
infection control and queue management.
are five consulting rooms for nurses, doctors, students and other health
far from enough.
The boardroom is used as a consulting room.
There is one counselling room.
store room and the
station in the
maternity wing are used as additional counselling rooms.
are inadequate beds in the maternity ward leading to patients sleeping on
are no observation rooms for stabilising patients.
is no internet network in the centre.
untraceable physical addresses which becomes
a challenge in contact tracing.
is failure in the community in taking responsibility for their own health.
experience aggression especially during weekends.
is a language barrier especially Portuguese and Chinese.
members do not honour their appointment days.
The delegation went on a walkabout at the health centre
and noted the following:
There delegation observed extremely long waiting times.
The time was around 16:00 in the afternoon
and when patients were asked how long they have been waiting they told the delegation
that they had been waiting since 6 oclock in the morning and have not yet been
There was no dedicated pharmacist in the pharmacy and
they use services of a regional pharmacist. There was only one pharmacy
assistant working in the pharmacy on the day of the visit.
There seemed to be no efficient filing system for
medical records. This could also be
a contributory factor to the long waiting times.
Oversight at Moses Kotane
Delegation from the Hospital
Ms M Mabe (Director District Hospital Services); Ms ME
(Acting Chief Executive
Officer); Dr GS Mangwame (Clinical Manager); Ms R Lebeko (Media and
Communication); Ms H Seemela (Assistant Manager-Nursing); and Ms K Khunou (Acting
Deputy Director - Administration).
The acting CEO Ms Scheepers led the delegation
delegation, starting off with the vision and mission of Moses Kotane and also
gave a background of the hospital.
Moses Kotane Hospital is a new revitalised
hospital situated in Moses Kotane Local Municipality within the Bojanala
District. Moses Kotane is a 230 bedded hospital serving 254 796 population and
a referral for 45 clinics and four health centres and referral for level two
services at JST Hospital. The hospital was occupied on the 17 May 2010 while
still under construction.
handover of the hospital took place on the 21 July 2011.
Services rendered at the
hospital are as follows:
Outpatient Department (OPD), casualty and emergencies,
obstetrics and gynaecology, medical, surgical, paediatrics, high care, theatre,
occupational health, choice of termination of pregnancy (CTOP), Comprehensive
Care and Treatment of HIV & AIDS, radiology, pharmacy, speech and
audiology, occupational therapy, physiotherapy, social services, dietetics,
dental and laboratory.
New units and services are
Ten bedded high care, six bedded neonatal ICU which will
be operational soon, six theatres, casualty and emergency unit, 15 bedded
private unit, clinical engineering, helipad and 39 residential units.
Opportunities for the
Digital X-Ray, private ward, second
phase of the hospital and nursing school.
The following were noted as achievements for the
hospital participated in the provision of health services during the 2010
hospital is being classified as the best facility in waste management.
hospital has received the cleanest hospital award.
Improving service delivery
The hospital has
identified and implemented the following strategies:
approach quality rounds, Management by Walking
(MBWA) at least twice a day.
managers are to visit their units daily to check for compliance.
are going to be conducted by quality assurance unit.
is development of monitoring tool/checklist by managers.
training and development will be introduced.
by both IPC and cleaning supervisors.
will be allocated on night duty mainly to cover OPD and casualty.
Ms Scheepers informed the delegation that the hospital is
facing the following challenges:
is no residential units for nursing students;
mortality rate due to the high burden of disease;
presentation for treatment by patients;
referrals and referrals to level two which is due to people bypassing
quality of security.
Having concluded the meeting the Committee had a walk
about in the hospital and noted the following:
were visible structural defects such as cracks on the walls and peeling
off in some areas.
delegation observed about two empty rooms that could have been utilised by
the hospital and the explanation was that some equipment were taken from
the hospital to JST Hospital and there was nothing given to the hospital
to replace these.
X-ray machine was incorrectly installed making it difficult to use and has
never been used since its installation.
Oversight at Pella Community
Delegation from the hospital:
Mr KS Boikanyo (Sub-District Manager); Mrs M Mabe (Director
- District Hospital Services); Mr BP Mekgoe (Facility Manager); Mrs SS Moabi (Assistant
Manager-Nursing); Ms ME Bolokwe (Director District Health Services); Ms R
Lebeko (Media and Communication); Mr L Kolobe (Parliamentary Liaising Officer);
Dr S Mangwane (Clinical Manager); Mr R Mosome
(Village Speaker - Executive Council); and Mr T Sokoko Traditional
Mr Boikanyo made his presentation and gave a background
and context of the district health system.
He mentioned that the White Paper for the Transformation of the Health
System in South Africa (1997) firmly positioned Primary Health Care as a
strategic approach for developing a unified health system capable of delivering
health care to all citizens of South Africa efficiently in a caring
This emphasizes the need to
decentralise the management of health services with an emphasis on the District
Health System (DHS) to increase access to Primary Health Care (PHC), in
ensuring safe and good quality outcomes and to rationalise health financing
through budget re-prioritisation.
He also noted that post 2009 elections, government
ushered in two key developments namely; the Green Paper on the National
Strategic Planning by the Ministry of Planning towards the development of the
National Plan 2030 and a Monitoring and Evaluation competency framework in the
Presidency which not only gave impetus to the strategic planning process but
also led to the development of the National Development Plan 2030 and the
signing of the Negotiated Service Delivery Agreement by Cabinet.
Mr Boikanyo informed the delegation that the Health
Centre has aligned its five year strategic plan (2009 -2014) and the annual
performance plan with both the NDOH ten point
well as the NSDA.
Similarly all the four
districts constituting the NWDOH namely; Bojanala, Dr Kenneth Kaunda, Dr Ruth
Segomotsi, Mompati and Ngaka Modiri Molema Districts have ensured proper
alignment to the NDOH and Provincial Department of Health (PDOH)
Sub-districts and hospitals
have also followed suit and Moses Kotane sub-district is no exception.
He also noted that the majority of the population in the
sub-district is black which
is 98.2%, whites 0.75%, Asian
0.49% and coloureds were the lowest population of 0.25%.
In terms of gender and age, the majority of
the population is 49.68% females and 50.31 males.
The 24.5% of the total population is between
the ages of 12 and 18 and the 38% of the population is between the ages of 60
and 70 years.
He noted that pre 1994 dispensation saw the health sub-district
having three district hospitals which were Derdepoort Hospital which was closed
in 2005, Moreteletsi Hospital which was closed in 2006 and George Stegman
Hospital which was later revitalised and became known as Moses Kotane
Transformation of health
services has been achieved given the number of health facilities within the sub-district.
Socio Economic Factors
The overall unemployment rate is 38% with the youth
unemployment rate at 43.2%.
The sub-district has 50 health facilities within four
health areas which are one district hospital, Mogwase Cluster with one
Community Health Centre and 12 clinicis, Mabeskrall one community health centre
and 13 clinics, Pella Community Health Centre, 10 clinics and Sesobe with 12
clinics , 36 mobile points and four health posts.
On emergency services, there is one station
at Moses Kotane, two satellite stations at Mogwase and Mabeskrall as well as
night service ambulance at Mokgalwaneng clinic.
The total number of private general practitioners in the whole
municipality is 11 with no private hospital.
Preventative, promotive, rehabilitative,
curative, and other support services like pharmaceutical and laboratories.
Referral System and ARV
All clinics within the cluster refer to the respective
community health centre and equally primary health care facilities refer to
Moses Kotane Hospital for all level one hospital services.
For secondary and tertiary health services Moses Kotane
Hospital refers to JST Hospital which has a Memorandum of Understanding with Dr
George Mukhari Hospital in Gauteng for tertiary and other special services. In
2012 the NWDOH HART Chief Directorate certified all the 49 health facilities to
provide ARVs even though there has been challenges in those facilities with
one professional nurse.
The Health Centre has developmental partners namely; the
ITECH and AURUM institute which assist them with the provision of training.
These have been handy in training nurses on
pulsa plus (14) and NIMART (55).
Challenges in ARV stock outs were only experienced once around January
2013 which was a result of supply from the provincial depot.
Phasing in of the Fixed Dose Combination (FDC)
been smooth and no challenges experienced thus
Challenges have been with supply of
other medicines and drugs from the hospital either due to the non cooperation
of the hospital pharmacy manager or stock outs. Joint management meetings
(Hospital and sub-district) were held to resolve the matter. Operational
managers also assist in reporting al stock out items to their respective cluster
managers who in turn inform the office of the CEO and the SD pharmacists.
Preparation for the National
Health Insurance (NHI) and Re-engineering of Primary Health Care (PHC)
In preparation for the NHI the presenter noted the
Bojanala has no NHI pilot project and DR Kenneth Kaunda
District is the provincial site and preparations for the roll out are preceded
by the implementation of among others through re-engineering of PHC and
national core standards, the sub-district re-engineering pilot site is
Tweelegte Village Ward 24 which has a population of 9530.
The SD has rolled out to nine wards.
Re-engineering of PHC
With regard to the re-engineering of PHC, the CHC is in
the process of recruiting retired nurses.
All appointed retired nurses are paid according to the Occupational
Specific Dispensation (OSD) with Grade three being the standard notch.
The retired nurses have been deployed mainly
according to their local places or abode and most are in Mogease Cluster.
He also informed the Committee that school
health services have started in June 2013 after the appointment of retired
The sub-district has no departmental revitalised
all projects are sponsored by mines and Sun City
(which are Sefikile Clinic which is 85% complete and Bakubung Clinic which is
Recommendations presented by
the sub-district office
Mr Boikanyo noted that the provision of excellent quality
primary health care services is dependent on resources like staff, vehicles as
well as equipment and budget.
recommends that the sub-district be afforded the opportunity to increase its
staffing of nurses in clinics, procurement of pool cars and or subsidy
He also recommended that the
budget for goods and services as well as equipment be increased.
Oversight at Mafikeng
Delegation from the hospital:
Mr AE Lourens (Chief Executive Officer); Mrs MJ Moromane (Deputy
Director Nursing); Dr TNC April (Acting Senior Clinical Manager); Mr M Madiwa
(Acting Deputy Director Corporate Services); Mr LR Lebotse (Acting Director
Finance); Mr L Kolobe (Parliamentary Liaising Officer); Ms M Tapologo (Assistant
Manager Nursing); Mrs D Lingiwe (Assistant Manager Nursing); Mr John
Smith (Assistant Manager Pharmaceutical Services); and Ms D Sibongile (Assistant
Mr Lourens made the briefing and informed the delegation
that late referrals remained a problem on high risk cases which leads to
maternal deaths which could have been avoided. The remedial action to this
challenge was to speed up the functionality of maternity waiting home.
The average length of stay (ALOS) is six days
and the bed utilisation rate is 75%. Performance was above target due to
payment of accruals in May 2013.
hospital had a challenge of broken laundry washing machines and boiler and that
they were taking their laundry to Klerksdorp and also using private
In compliance with the six priorities of the core
standards he noted the following:
availability was at 71%, instead of 93%;
was at 77% as opposed to 87%;
patient safety and security, there were nine abscondments reported and
nine recaptured and security has been distributed to all vulnerable areas;
attitude was at 19.6%;
time at 2hrs and 42 minutes; and
It was noted that for the first quarter the hospital had
nine maternal deaths which were all HIV related.
On nosocomial infection rate, the hospital
was still meeting the target on performance but they were still experiencing
delays in getting results on time from the laboratory and the matter was being
attended to by the laboratory.
The delegation went on a walkabout at the hospital and
noted the following:
On the day of the visit there were six beds in a four bed
Staff shortages were also
the ward has only eight nursed during the day
instead of 12.
There was no privacy
between the patients as there were no curtains between the beds.
Wall paint was peeling off in the ward.
The sister in charge informed the committee that the ICU
was 80% understaffed.
They have 14
registered nurses instead of 25. They use old models of ventilators that were
bought in 1997.
Of the old ventilators,
only three are functioning.
Lehurutshe/Zeerust Hospital Complex
Delegation from the hospital:
Mr N Mosiane (Chief Executive Officer);
Ms ME Kaudi (Director Hospital Services); Ms MH Kgatitsoe (Deputy Mananger
Nursing); and Dr BS Belle (Clinical Manager).
Mr Mosiane briefed the delegation and provided a
background of the hospital complex.
noted that Lehurutshe and Zeerust hospitals are two hospitals that operate as
hospital complex and are 17 kilometres apart.
The hospital serves a population of about 143 095 in Ramotshere-Moiloa sub-district.
The hospital complex serve as a district
hospital to four health centres, 16 clinics, two health post and six mobile
clinics in Ramotshere-Moiloa Sub-district.
The hospital complex provides level one hospital services in terms of
the District Health System in Ngaka Modiri Molema district. The hospital complex
is managed by one management team consisting of CEO, clinical manager, nursing
service manager and Administration Manager.
Services that are provided at Lehurutshe are OPD and
casualty paediatric, maternity, female wards, theatre, X-ray department, physiotherapist,
occupational therapist and social work services, pharmacy and wellness
The hospital has two infection
control coordinators and they manage IPC and TB programmes.
Zeerust offers an outpatient department and casualty male
and female wards, theatre, X-ray department, physiotherapist, occupational
therapist and social work services, pharmacy and wellness clinic.
In terms of referrals, the hospital complex
refers patients who need level two services to MPH and BPH for psychiatric
On staff complement, the hospital complex is served by
335 staff members, 172 at Lehurutshe and 163 at Zeerust with two retired nurses
Among the staff members
the hospital is having a total of 13 doctors who are pooled together and
managed by one clinical manager.
doctors operate from the hospital and do outreach to clinics and health centre
and they are also complemented by sessional doctors who are serving the
hospital after hours.
Mr Mosiane also noted that the hospital complex was
implementing and monitoring the key six key priorities:
of hospital environment
Prevention and control
and security of patients and staff
Drug availability and FDC
Drug availability was at 96% in terms of EDL (Essential
Drugs List) for district hospitals. ART patients started on FDC were 113 and 81
for Lehurutshe and Zeerust, respectively.
The budget allocation for 2013/14 was as follows:
of employees : R74 922 000
and Services: R26 739 698
and equipment : R766 00
mortality is high which is thought to be due to induced illegal abortions.
transportation remains a challenge.
of laundry services within the hospital premises.
Having concluded the meeting the committee was taken on a
tour of the hospital and noted the following:
There is a well equipped training centre.
The centre is for students from the faculty
of health science at the University of Witwatersrand.
The centre is a collaborative partnership
between the North West Department of Health and the University of
Accommodation for the
students is provided by the hospital.
The budget for the centre is held by the district.
Oversight at Klerksdorp
Delegation from the hospital:
Mr P Mokatsane (Chief Executive Officer); Mr Mobai
(Deputy Director Corporate Services); Mrs MM Dikane (Deputy Director
Nursing); Mrs JJE Oosthumer
Director Quality); Mr J Drotskie (Administrative Manager); Mrs M Dichabe
(Core Standard Manager); Dr M Diching-Mahole (Clinical Manager); Ms K Randeree (District
Hospital Services); Dr U Nagpal (Programme Manager NHI); Dr MD Leburu (Clinical
Manager); Mr A Chabedi (District Coordinator
NHI); Mr L Kolobe (Parliamentary Liaising Officer); Ms M Mabale (Protocol
Ms N Mojanaga (Chief Director
District); Mr K Ndincede (MME Health); and
Ms NS Mendela (Councillor).
Mr Mokatsane made the presentation and gave the vision,
mission and values of the province.
highlighted that their reputation for caring and serving stems from the African
tradition of ubuntu.
To do this the
hospital manages its resources efficiently and responsibly.
Their strength lies in creating an
environment that respects and welcomes diversity of faith and cultures.
The hospital also recognises its special
responsibility to the poor.
The Klerksdorp hospital is 829 bedded developing tertiary
hospital complex situated in Dr Kenneth Kaunda District in the Matlosana sub-district.
Of the 829 beds, 467 beds are in Klerksdorp,
382 beds are in Tshepong and 98 are at the MDR/XDR centre.
Nine of the ten theatres are functional in
Klerksdorp and five are in Tshepong.
hospital renders 24 hour level one
Matlosana, level two for Dr Kenneth Kaunda and level three for the whole
Services provided at the
hospital are as follows:
Radiology, pharmacy, paediatrician, orthopaedic,
ophthalmology, Radiation oncology, renal, anaesthesia, internal medicine,
wellness MDR/XDR, laboratory, catering, provincial laundry, information
technology, Thuthuzela, Male Medical Circumcision and HCT.
Challenges and interventions
On challenges the CEO mentioned the following with possible
attitude staff engagement conducted and expected daily behaviours is
that the staff greet the patients and ask for permission if they need to
conduct any tests and thank the patient afterwards.
waiting times - there are queue management staff who attend to patients.
lack of capacity - is in-house capacity building and alternative funding
initiatives are taken.
the issue of obsolete HCT - there is maintenance and replacement plan that
focuses on life support.
shortage of hospital beds - there is a decongestion plan.
shortages - the AHP will assist to recruit in the shortage of specialists
of ward-based electronic data system and information audit has been
conducted to address the inadequate date management.
patient bell system and a security plan have been introduced to attend to
Primary Health Care
There is a functional
district health council, hospital boards, governance structures and clinic
All health facilities are
management teams are in place to guide primary health care re-engineering.
District Clinical Specialist
been appointed and functional.
School health teams have
Seven hundred and sixty
community health workers have been employed on persal.
Two hundred and twenty one
community health workers have been deployed in primary health care engineering.
Fifteen primary health care
nurses have been deployed in primary health care re engineering.
Three hundred and twenty
seven community health workers have been trained on ward based approach.
Twenty five primary health
care nurses have been trained on ward based approach.
Forty-one (41) retired
nurses have been appointed.
In addressing the
Intergrated Chronic Disease Management (ICDM) fast lanes have been introduced
and issuing of two to three months medication to patients who adhere to
Progress on the National Health
Dr Nagpal presented on progress and challenges during the
first 15 months of the implementation of the NHI in the North West and noted
Kenneth Kaunda District was declared as an NHI pilot district in March
A conditional grant budget of
11.5 million was received in 2012/13 and 4.85 million in 2013/14.
of its achievements is that in the first year the emphasis was on
strengthening district health services and primary health care reengineering.
improvement teams were also established at provincial and district level
and were supported by the national fit team.
Health Systems Strengthening
On district health systems strengthening Dr Nagpal noted
subcommittees were established with experts and representation from
sub-districts and district office as follows:
Resource planning and development.
Projects undertaken are as follows:
facilities were assessed by experts reporting on condition of facility,
maintenance required and the bill of quantities.
work has been completed in some and ongoing.
Minor maintenance work was done in all
districts and maintenance projects completed at a cost of 8.577 million from
was commissioned for 22 clinics and all nine health centres. Repairs,
replacements and earthing, covering of wires etc was done in all the above
referred facilities and they now have compliance certificates.
equipment needs analysis has been completed.
equipment procured and distributed.
team involved in developing equipment maintenance plans.
equipment needs also completed.
primary health care facilities have been provided with needed IT
equipment required for specialist outreach teams, school health teams and
master trainers have been procured.
for community health workers to screen chronic diseases and communication
is being procured.
On pharmaceuticals the following were noted:
pharmacist assistant (post basic) was employed at Grace Mokhomo Community
The Centre showed
the most improvement on drug availability and waiting times.
The availability improved from 70% to
The pharmacist assistant
assisted Kanana Clinic and it also showed drug availability improvement
from 61% to 81%.
pharmacist assistant that were trained on the basic course last year are
being trained on post basic.
of standard operating procedures for clinic pharmaceuticals services was
and sub-district pharmaceutical and therapeutic committee meetings have
Inspection of facilities has
Reports have been given
to sub-districts on cleanliness, infection prevention and control, patient
safety, drug availability, staff attitude and waiting times to make
Improvements have been
noted in most facilities.
benchmark with best practicing institutions.
Customer care training and
cleanliness training conducted.
Self assessment for
compliance to National Core Standards has been completed in all facilities in
Terms of reference for
functioning of the district National Core Standards and sub-district teams has
been signed off by the Chief Director and schedule for visits to facilities has
Human Resource Management
Regional training centre (RTC)
has been established at the previously redundant
home in Tshepong hospital through renovations.
RTC manager has been
Equipment has been procured.
Clinical associates have
been housed on top floor.
In-house training was done
to save costs on venue.
Master trainers have been
Health Services Training
has been completed in preparation for the implementation of the NHI.
in finance for non financial managers has been conducted.
of governance structures in Monitoring and Evaluation has been conducted.
physicians were trained in PMDS to manage contracted GPs.
were afforded a cleaning course.
on infection control in ambulatory facilities was provided to EMRS and
training to data capturers and clinic clerks was conducted.
training of staff in demand planning, acquisition and asset management has
been arranged and will take place in the second quarter.
team working on the WISN (Workload Indicators of Staffing Need) project
has completed its work.
has been submitted.
referral policy for the district has been revised by the specialist
outreach team to include referrals by community health workers and school
On governance the following were noted:
levels of governance structures are established and functional and training
other districts that are not piloting have been invited to meetings so
that their development and ability to implement NHI is simultaneously
strengthened through their equitable share.
expenditure for 2012/13 was at 76% and including commitments at 96%.
Rollover for committed orders has been
remaining 4% was not spent as it was for specialist teams and they were
to date for this year is as 20% and with commitment at 26%.
Challenges and proposed interventions
The following challenges on NHI and proposed solutions
for NHI is inadequate as only 4.85 million has been allocated out of 26
funds at National Department of Health were for appointing GPs and for
To date only
three GPs have been appointed in the district and there is no money spent
by the National Department of Health (NDOH) on facility improvement.
It is unlikely to be spent and may have
to be returned.
A quick evaluation
of how much will be required and allocation of the remaining two districts
will assist in wise spending on much needed equipment and maintenance. Centralising
appointments and expenditure at national level leads to delays in
It also gives a
message of inadequacy to service level staff and is demoralising.
It is also contrary to NHI requirement
where decentralising is the key.
the advantages of economies of scale in centralisation process, the
decentralisation needs to happen.
district does not have enough staff
establish a planning, monitoring and evaluation unit.
National Core Standards need to be met for the NHI success.
Neither the district structure nor
budget will be able to appoint someone for quality assurance.
The Provincial unit may work offsite to
ensure accreditation and readiness.
services at district/sub-district level may help alleviate staff shortages
in rural areas in Supply Chain Management (SCM) and finance.
Having received the presentation and raised immediate
concerns the delegation went on a walkabout, and noted that the hospital has
implemented admirable innovations such as the introduction of labour companions
at the maternity unit. This is lauded as one of the first innovations to be
introduced in a South African hospital. Also noted is the oncology unit with
state of the art equipment and technology. To improve waiting times and
way-finding, the hospital has also introduced a colour coding system.
at Orkney Clinic
The facility manager, Ms E Lesekeli informed the delegation
that the clinic renders comprehensive primary health care services.
The working hours for the clinic were from 7:00
in the morning to 16:00 in the afternoon on Mondays, Thursdays and
On Tuesdays and Wednesdays the
clinic operated from 7:00 in the morning to 19:00 in the evenings.
Patients book appointments and their files are kept
readily available for when they arrive. Those who miss their appointments are
rescheduled for a day the same week they were supposed to come. The clinic has
also ways of tracing defaulters.
nurses are employed and their line of duty is to prepare medication for the
This also assist in making
sure that patients are attended to quickly.
The delegation had an opportunity to have a walk about at
On arrival the delegation
noted that the clinic was very clean. The clinic also uses the colour coding
system which is also being used at the hospital.
There were different colour foot prints on
the floor which the clinic used to direct patients where to go.
The yellow one was for minor illnesses, blue
for chronic and green for maternal and child care. This also assists those
patients who cannot read. This showed to be an effective innovation as it
reduced waiting times and patients know where to be attended.
Patients collecting chronic medication do not
the clinic has a system of attending to
In making sure that there are no drug stock outs, drug
availability is checked twice a month. There is a sessional doctor who comes on
Mondays, Wednesdays and Fridays to attend to patients at the clinic.
at the MDR Unit
The delegation had a walk about at the MDR Unit and was
taken to a tour of the unit by Dr Ferran.
Dr Ferran informed the delegation that they had two phases in the unit,
phase one and two.
Phase one was like a
step down and was used for patients who have tested negative on their
Phase one was a four bedded
unit. Phase two was for acute.
notable is that the MDR unit had effective ventilation systems, both natural
and mechanical ventilation.
Oversight at Witrand Physical
Medicine and Rehabilitation Unit
The unit was opened in 2005.
They attend to patients with spinal cord injuries.
The unit is well equipped and with technology
to perform urodynanics which is used to assess bladder functioning in spinal
cord injured patients. There is also a well equipped gym and a hydrotherapy
pool which is used by patients as part of their rehabilitation. There are
beauty therapists who also attend to the patients.
Meeting with the Member of
Executive Committee (MEC)
Officials who attended the
Dr M Masike (MEC); Mr A Kyereh (Acting Head of Department);
Mr A Kyereh (Chief Financial Officer); Dr FRM Reichel (Head of Department
Support); Mr BCS Redlingys (Forensic Medicine); Mr Mavundza (Chief Executive
Officer); Mr PT Mokgabi (Hospital Chairperson); Mrs M Mabe (Director); Ms R
Ms M Mabale
(Protocol Officer), Ms S Mohube (Personal
Assistant to the MEC); Mr KS Boikanyo (Acting CEO); Mrs MA Mohutsioa (Acting
Director Primary Health Care);
Henning (Chief Director District Health Services); Ms Wiebe-Randeree (Director
Hospital Services); Ms C Sebekesi (Chief Director); Dr U Nagpal (Deputy
Director General (DDG) NHI);
Robinson (DDG); Ms M Seitisho (Director MEC Office); Ms M Tlhogane (Director-
Special Progammes); Ms V Moremi (JST Board Chairperson);
Ms R Tshehle (HOD Support);
Ms V Mbulawa (Corporate Services); Mr T
Lekgethwane (Director Communication); Dr Bogosi Moagi (Senior Clinical
Manager); Mr P Mokatsona (CEO); Ms ME Rakau (Chief Director); and Mr L Kolobe (Parliamentary
Comments and concerns
The delegation commented on the following significant
The delegation was
bothered by long waiting times observed in most health facilities visited,
with some patients waiting longer than 6 hours.
Safety and security
issues were also raised as a challenge in most facilities.
The shortage of
Emergency services and long response times was raised as a concern by the
The delegation raised a
concern on private wards and the impact of these on the NHI.
The issue of public
private partnerships (PPPs) with the mining and tourism industry in the
province needs to be explored.
A report on provincial,
district and local aids councils on their work and its impact should be
submitted to Parliament.
Responses from the MEC
The office is
aware of the challenge and one of the
that leads to it is the staff shortages.
The challenge is being addressed.
The tender for security went out
the previous date and they are hoping this will improve security.
on private wards:
does not have a policy on private wards.
in addressing the
challenge the province has bought a helicopter for emergency transport.
and XDR units:
The province is
opening these units with the hope of closing them again.
This will be done by taking care of
people so that there are no defaulters.
Findings made by the
shortages were indicated in all health facilities visited.
Health care workers are overburdened which
further lead to long waiting times.
is an indication of a growing population in some of the
this presents a challenge in terms of bed allocation in most facilities, which
seems not to be meeting the growing population (for example JST hospital had
396 beds which were reduced by 60).
budget allocated for the institutions is not enough which leads to budget
influencing their plans and not the other way around.
transport is a major challenge as officials have to use their own personal cars
for official duty.
shortages was identified which contributes to overcrowding wards.
This was more apparent in ward 9 in Mafikeng
Hospital and Boitekong Community Health Centre.
is a lack of laundry services within some facilities and have to travel more
than 200 km to get their linen laundered.
some facilities there was underutilisation of space.
shortages of linen were identified in most institutions visited.
concerns were identified in some of the health facilities.
facilities reported higher maternal mortality rates (Moses Kotane) and
perinatal deaths (Lehurutshe Hospital).
were equipment shortages in some health facilities.
For example, in Moses Kotane Hospital, a
mammogram machine was taken to JST Hospital and they were never given anything
to replace it which makes it difficult for the hospital to screen their
plans are not updated. At Mafikeng Hospital old ventilators are being used
which were bought in 1997 and only three are functioning.
X-ray machine was not properly fitted at Moses Kotane Hospital and was never
used. The hospital is utilising a chest X-Ray which is a problem as patients
have to stand even if they are not able to stand.
infrastructure maintenance was identified in some facilities.
issue of high teenage pregnancy was found to be a serious concern, together
with a high number of requests for termination of pregnancy.
ramps were lacking in one of the facilities visited (Lehurutshe Hospital
delegation was also concerned that there is no health tourism, particularly
around the Sun City area.
absence of a tertiary hospital in the province presents a challenge as patients
who require tertiary care have to be transported to other provinces.
Achievements and innovations
The following were noted by the Committee in the
different health institutions visited:
the visited public health facilities were very clean.
delegation commended Lehurutshe Hospital for their zero maternal mortality.
reduction of waiting times at JST Hospital was also noted.
well equipped and functional renal unit at JST Hospital was praised by the
levels of medicines and supplies were found to be managed properly in all the
visited facilities have rolled-out the FDC.
Tshepong Hospital has implemented some great innovations such as laparoscopic
caesarean; the use of labour companions for maternity; queuing system; a burns
unit; and a well equipped radiology unit.
district is making progress in terms of implementing the NHI policy.
well resourced MDR unit.
The delegation also commends
the province for its state of the art rehabilitation facility.
The Committee recommends that the Minister of Health
should ensure the following:
province should attend to the issue of staff shortages and gaps as a matter of
urgency and must report to the Committee on progress made within six months.
should make sure that they have the relevant equipment and equipment
maintenance plans are in place.
province should adopt a needs-based approach to budgeting and meet with the
hospitals to determine the actual needs of the hospitals and budget
The planning should inform
the budget and not the other way round.
National Department of Health should attend to the issue of a tertiary hospital
and should assist the province in making sure that it has a tertiary hospital.
scale-up in implementing strategies and interventions to improve patient
address high mortality rates through research into factors that contributes to
mortality rates and implement evidence-based targeted interventions.
the issue of ambulance/patient transport as this can improve mortality rates.
resource planning to address sufficient bed allocations in order to ensure the
appropriate number of beds provided for pregnant women.
Report to be considered.
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