ATC151013: Report of the Select Committee on Appropriations on the oversight visit to National Health Grant (Health Facility Revitalisation Grant Projects and National Health Insurance Grant Project) in Kwazulu-Natal Province, dated 13 October 2015

NCOP Appropriations

REPORT OF THE SELECT COMMITTEE ON APPROPRIATIONS ON THE OVERSIGHT VISIT TO NATIONAL HEALTH GRANT (HEALTH FACILITY REVITALISATION GRANT PROJECTS AND NATIONAL HEALTH INSURANCE GRANT PROJECT) IN KWAZULU-NATAL PROVINCE, DATED 13 OCTOBER 2015

Introduction

The Select Committee on Appropriations (the Committee) resolved to convene public hearings on conditional grant expenditure reports and conduct oversight visits to the identified projects in the provinces. The first province that the Committee of the Fifth Parliament decided to visit was KwaZulu-Natal. The Committee requested the national and provincial Departments of Health and National Treasury to make oral and written submissions on KwaZulu-Natal’s National Health Insurance (NHI) Grant financial and non-financial performance reports as at 31 March 2015.

The NHI and Health Facility Revitalisation components are two of the three components of the National Health Grants.

The strategic goal of the National Health Insurance component of the grant is to improve the performance of the District Health System (DHS) through testing service delivery and providing innovations in readiness for the implementation of the National Health Insurance (NHI).

The purpose of the NHI component of the grant is to:

  • Test innovations in health services delivery and provision for implementing NHI, allowing each district to interpret and design innovations relevant to its specific context, in line with the vision for realising universal health coverage for all;
  • To undertake health system strengthening activities in identified focus areas; and
  • To assess the effectiveness of interventions/activities undertaken in the districts funded through this grant.

The strategic goal of the Health Facility Revitalisation component of the grant is to ensure that appropriate health infrastructure is in line with national and provincial policy objectives.

The purpose of the Health Facility Revitalisation component of the grant is:

  • To create an alternative track to speed up infrastructure delivery, to improve spending, performance, and monitoring and evaluation of National Health Insurance (NHI) pilots and infrastructure projects; and
  • To enhance capacity and capability to deliver the infrastructure for NHI pilots.

 

  1. Terms of Reference

The Committee was established in terms of section 4 (3) of the Money Bills Amendment Procedure and Related Matters Act, No 9 of 2009. In terms of section 4 (4) of this Act, the Committee has the powers and functions conferred to it by the Constitution, legislation, the standing rules or a resolution of a House, including considering and reporting on:

  1. Spending issues;
  2. Amendments to the Division of Revenue Bill, the Appropriation Bill, Supplementary Appropriations Bill and Adjustment Appropriations Bill;
  3. Recommendations of the Financial and Fiscal Commission, including those referred to in the Intergovernmental Fiscal Relations Act, No. 97 of 1997;
  4. Reports on actual expenditure published by the National Treasury; and
  5. Any other related matter set out in this Act.

Furthermore, the mandate of the Select Committee on Appropriations (henceforth referred to as the Committee) encompasses the Committee’s functions to legislate, conduct oversight of the Executive; promote public participation, facilitate international agreements and review matters of public interest in relation to the National Treasury. 

  1. Objectives

The objectives of the oversight visit were to:

  1. Assess the status of the projects funded by the grants;
  2. Ascertain whether projects were in line with business plans;
  3. Appreciate the service delivery initiatives and implementation thereof; and
  4. Assess if the expenditure reports received were a true reflection of projects status.

 

  1. Methodology

The methodology applied was conducting hearings on both financial and non-financial performance of the National Health Insurance Grant and also conducting oversight visits to specific projects to assess the value of the money spent.

  1. Hearings

In preparation for the oversight visit the Committee conducted the hearings on 09 June 2015 whereby the National Treasury and National Department of Health (NDOH) made a presentation on the National Health Insurance (NHI) Grant. The purpose of the hearing was to assess both financial and non-financial performance of the grant as of 31 March 2015 as well as the preceding financial years.

  1.  Financial performance

The NHI grant comprises of both direct (managed directly by provincial health departments) and indirect (managed by NDOH on behalf of the provincial health departments) portions.

The direct grant started in the 2012/13 financial year with an allocation of R150 million, followed by R350 million in 2013/14 and R500 million in the 2015/16 financial year. The indirect component started in the 2013/14 financial year to deal with under-spending and poor performance of the direct portion.

Generally the NHI indirect component of the grant spending was 3.3 percent in 2012/13 and 20.8 percent in the 2014/15 financial year. For the period under review the NHI direct portion of the grant spending was 81.7 percent for 2013/14 and decreased to 69.3 percent in 2014/15.

Due to this under-spending some of the funds were reprioritised from the grant in both components during the budget review for the 2015 Medium Term Expenditure Framework (MTEF).

The provincial spending ranged from 20 percent spending in the Eastern Cape to 42 percent in Mpumalanga, 52 percent in Northern Cape, 54 percent in Gauteng, 77 percent in Western Cape, 84 percent in North West, 87 percent in KwaZulu-Natal, 88 percent in Free State and 93 percent in Limpopo.

At the end of the 2014/15 financial year, a total of R5.6 billion or 95.7 percent was spent in respect of the R5.8 billion allocated to the Health Facility Revitalisation Grant. Expenditure of this grant increased by 19.9 percent in 2014/15 when compared to the R4.7 billion spent at the end of the 2013/14 financial year.

Mpumalanga Province reported the least expenditure of all the provinces at 79.0 per cent, followed by the Northern Cape Province (85.1 percent) and Western Cape Province (85.7 percent). The rest of the provinces showed sufficient spending with North West at 96.6 percent, Gauteng and KwaZulu-Natal both at 100 percent and Limpopo at 108 percent.

  1. Non-financial performance

Over the period under review the Department of Health tested the effectiveness of three service delivery models – direct contracting of general practitioners (GPs) through the department, contracting via service providers and the Western Cape service delivery model whereby contracted GPs are kept at the hospitals and GPs employed are utilised for the pilot projects.

The following is the reported non-financial performance of the NHI Grant:

  • As of 31 March 2015 the total number of contract GPs was 256.
  • As of 31 March 2015 the GP primary health care (PHC) facility coverage was 98.28 percent as compared to 81.03 percent in 2014.
  • The NDOH further indicated that due to budget cuts for the 2015/16 financial year only 156 full time equivalent doctors could be contracted against the 450 target.
  • As of 31 March 2015 national district clinical specialist support recruitment status showed that in total 220 practitioners were recruited.
  • As of 31 January 2015 about 752 ward-based primary health care outreach teams were registered compared to 434 in 2014 against the 1 976 target.
  • To improve the school health services additional school health mobile vehicles were purchased and distributed in the NHI pilot districts (27 mobile PHC trucks, 17 oral health mobile trucks and 3 eye care mobile trucks).
  • About 53 656 registers were purchased of which 21 236 were delivered to districts for rationalization of registers. This exercise resulted in the following outcomes: Reduced waiting time, reduced workload, uniform and easy data collection, reduced duplications, nurses having more time with patients, and improved reporting.
  • As of 31 March 2015 patient registration in the NHI pilot districts reflected 397 456 of whom 316 406 patients were captured at Beta sites while 81 050 were imported from registers.
  • For the financial year ending 31 March 2015 the NDOH spent over R201.2 million in donor funding to supplement NHI pilot projects.
  • The Department further presented a detailed NHI pilot site appraisal in each district.

 

  1. Challenges

Some of the reasons advanced for the under-spending are:

  • Supply chain management delays;
  • Restrictive environment and lack of sufficient delegations at the district level;
  • Staff challenges at the district level;
  • Effective implementation of NHI pilots requires supplementary provincial equitable share funding, which provinces have not catered for;
  • In Eastern Cape where spending was the lowest the following were cited as contributing factors:
    • Grant conditions are restrictive and impede the effective use of the allocated budget;
    • The allocated amount is not sufficient to holistically cater for the planned activities;
    • There is a need for better coordination on NHI pilots across national, provincial and local levels and development partners.

 

  1. Oversight visits:
    1. Site visit to the Ngwelezane Hospital (Health Facility Revitalisation Grant)

During the oversight visit to KwaZulu-Natal the Committee conducted a site visit to the hospital premises on Monday, 17 August 2015 where presentations were made by the hospital management and Public Works representatives. During the site visit the Committee delegation further made a tour within the hospital to assess the quality and status of the project.

  1. Background

This is a tertiary hospital that is situated in Empangeni and was built in 1844. The hospital is supposed to render regional and tertiary services for Uthungulu, Zululand and Umkhanyakude but still render district services to Umhlathuze, Mfolozi and Ntambanana sub-districts. It is a referral hospital for 18 hospitals in the region and also looking after 16 primary health care clinics. The hospital has an average of 14 000 out-patient department (OPD) headcount per month. Initially Ngwelezana Hospital was intended to be one of the T.B settlements in the Province. The hospital has grown to be one of the largest hospitals in District 28.  The hospital has a staff of over 1 200.

  1. Nature and status of projects

The following are the projects that have been completed:

  • Upgrade of Wards E, F and the ICU that commenced in January 2003 has been completed at a final cost of R3.9 million.
  • A new perimeter fencing has been constructed at a final cost of R989 876.58 in 2007.
  • Construction of new trauma and casualty commenced in March 2006 and was completed in July 2007 at a final cost of R21.7 million.
  • The refurbishment of reservoirs, pump house and related work commenced in July 2010 and was completed in March 2013 at a final cost of R5.4 million.
  • Construction of the new psychiatric ward, including a new helipad, commenced in uly 2008 and was completed in October 2009 at a final cost of R21.8 million.
  • Construction of a new therapy department commenced in January 2011 and was completed in February 2012 at a final cost of R9.5 million.
  • Construction of a new psychiatric outpatient clinic commenced in May 2011 and was completed in June 2012 at a final cost of R6.7 million.

Construction of two new wards and demolishing ward A (including Nurses College) commenced in January 2011 and was scheduled for completion in March 2015 but has been extended for completion by the end of August 2015. The cost of the construction is R54.8 million.

The work on MV and LV electrical reticulation including upgrade of existing corridors, mortuary, workshops and transport offices, commenced in May 2011 and was scheduled for completion in September 2014 but has now been extended for completion by the end of August 2015.

The project for the construction of a three storey building, 192 beds for adult patients in surgical wards, including a new crisis centre and perimeter fencing at a projected cost of R288.3 million commenced in July 2014 and is scheduled for completion in January 2017. It is however unlikely that the project will be completed on time. The state of the pillars for the three storey building might need a technical assessment to ascertain their appropriateness.

Some of the challenges reported were as follows:

  • The balustrade on the first floor of the nurses’ college had to be rectified earlier on;
  • Doors to DB cupboards of nurses’ college also had to be completed and rectified;
  • The contractor had to replace kerbing in the road damaged by a truck removing containers; and
  • The flooring in the corridors of the hospital’s western end was being damaged at an alarming rate, this is reportedly due to vehicles being driven on this floor, including the trailers which have cast iron wheels while some trailers have polyurethane castors that are hard and also damage the floor.

 

  1. Site visit to Edendale Hospital Project (National Health Insurance Grant and Health Facility Revitalisation Grant)

During the oversight visit to KwaZulu-Natal the Committee conducted a site visit to the Hospital premises on Thursday, 20 August 2015 where presentations were made by the hospital management and Public Works representatives. During the site visit the Committee delegation further made a tour within the hospital to assess the quality and status of the projects.

  1. Background

Edendale Hospital is a Regional Hospital fully recognized for post-graduate teaching in all major disciplines. It has 900 beds and is the fourth biggest hospital in the country. The Hospital first opened its doors for patients on 01st March 1954 with 620 beds. It is situated in Umgungundlovu District, which is the second most populous district in KwaZulu-Natal Province. It serves a population of approximately 1.4 million, including the greater part of Umgungundlovu District and Sisonke District with high levels of unemployment, poverty and poor education, and is predominantly rural. The Hospital provides a number of specialised services.

  1. Nature and status of project/s

The following projects are funded from the health facility revitalisation component of the grant to ensure that the hospital facility is upgraded in phases to a suitable condition to deliver the essential health care services within the area:

  • A new CD clinic and ARV pharmacy with an original contract amount of R41.1 million which was later revised to an amount of R47 million due to some changes in the scope of the project during construction. The original contract period was 20 months, but the project was completed after 30.5 months on 16 September 2014. Some of the factors that led to the delay were changes made during construction and weather conditions.
  • The upgrade of the psychiatric department with an initial contract amount of R7.6 million which was revised to R6.8 million. The downwards revision of the contract amount was due to the need to omit certain items during the construction period. The contract period was for eight months, but the project was completed after 12.5 months on 26 May 2014. The construction period was extended because after commencement of the construction unknown as-built conditions were discovered that required the consultants to amend their designs and provide specific additional support. Other factors included non-availability of certain materials.
  • Alterations and additions to the accident and emergency and out-patient department. The original contract amount was R62.6 million and the revised contract amount is R65.7 million. The initial construction period was 15 months, but phase 1 of the project was completed after 31.5 months on 11 November 2014. Phase 2 of the project is reportedly about 80 percent complete. The revised contract amount was due to the need to make some changes on the scope of work after construction commenced.
  • Conversion from steam to electrical heating. The original contract amount was R17.5 million which was revised to R19.9 million. The construction period was for 9 months and commenced on 12 June 2012. The construction is still incomplete because the contractor experienced financial difficulties that led to liquidation. Although the contract was subsequently terminated the anticipated final account value of the contract is already at R18 million. Apart from challenges with the contractor, there was also insufficient/incorrect information provided by the consultants. The contract of the consultants responsible was also terminated while the contract for the project has been re-advertised.
  • Upgrade of roads and parking with the original contract amount of R6.3 million and revised contract amount of R6.8 million. The revised contract amount was due to changes made during the construction period. The project period was for 8 months, but was completed after 17 months on 12 November 2014.
  • Sewer and water upgrade project with original contract amount of R3.025 million and revised contract amount of R3.078 million. The revised contract amount was due to the inclusion of non-return valves during the construction period. The project period was 6 months, but was completed after 8 months on 05 April 2014.

 

  1. Site visit to King Dinuzulu Hospital Project (Health Facility Revitalisation Grant)

During the oversight visit to KwaZulu-Natal the Committee conducted a site visit to the hospital premises on Thursday, 20 August 2015 where presentations were made by the hospital management and Public Works representatives. During the site visit the Committee delegation further made a tour within the hospital to assess the quality and status of the projects.

  1. Background

The hospital, then King George V Jubilee Hospital, opened with 139 beds in 1939. In 1956 the hospital merged with the adjacent Springfield Military Hospital with a total of 1 291 beds. Additional services that were incorporated included psychiatry, oesophageal surgery, thoracic surgery, family planning and oral and dental services. Currently the hospital is a referral institution for sixteen clinics (primary health care). The hospital has a current total budget of R559.1 million (for 2015/16) of which R401.9 million (71.8 percent) is the cost of employees and R155.2 million (27.7 percent) is for goods and services. The major challenges are reportedly staff shortages and budget constraints. The hospital revitalisation project commenced in 1997 and is scheduled for completion in 2015. The delay in completing the project is negatively impacting on the institution’s capacity to deliver services.

  1. Nature and status of the project

This is an old hospital whose buildings and facilities were in a state where they needed upgrading and replacement. Due to budget constraints and the necessity of a working hospital the Redevelopment Committee of the hospital decided that the existing hospital operations should continue while construction is under way. The construction project was phased in six phases beginning from 01 April 1999.

Phase 1 comprised of two projects, 1 – 2, that were completed in 2002. Project 1 was the conversion of a multi-storey building into TB Wards at a contract amount of R17.1 million and Project 2 was the conversion of then staff accommodation into a dental facility at a contract amount of R7.2 million.

Phase 2 comprised of six projects (3 – 8) with a contract period scheduled for the period 1 August 2000 to 01 March 2007. Project 3 (bulk earthworks and parking) has been completed (at a contract amount of R43.4 million for bulk earthworks phase B, at a contract amount of R12.7 for bulk earthworks phase 1 and at a contract amount of R12.3 million for bulk earthworks phase C). Project 6 (new kitchen/cafeteria/dining room) has been completed at a contract amount of R27.3 million, Project 4 (re-route services) has been completed at a contract amount of R8.8 million. Project 4 (re-route services phase B) at a contract amount of R10.8 million has reached final completion but accounts are still to be made. Project 5 (construction of new level 1 hospital) at a contract amount of R454.2 million has reached final completion but accounts are still to be made. Project 7 (new workshops and mini laundry) at a contract amount of R25.2 million has reached final completion but accounts are still to be made. Project 8 (new main entrance and security facilities) at a contract amount of R6.7 million has reached final completion but accounts are still to be made.

Phase 3 comprised of seven projects (9 – 15) and the construction period was scheduled for 01 April 2004 to 10 September 2008. Project 12 (new TB surgical wards and mortuary) was completed with a contract amount of R49.9 million. Project 15 (new psychiatric closed unit) has been completed at a contract amount of R9.3 million. Another phase of the project was refurbishing of the existing psychiatric hospital at a contract amount of R25.2 million. Project 9 (new TB wards) has been completed at a contract amount of R25.7 million. Project 11 (upgrade of the TB kitchen to Laundry) has been completed at a contract amount of R336.8 thousand.

Project 12 (new TB covered walkways) construction is still incomplete and behind schedule and the current contract amount is R564.0 thousand.

Project 10 (TB surgical outpatient department - administration and admissions) at a contract amount of R28.2 million has not yet started but the contractor is reportedly on site.

Two contracts for Project 9 (new TB wards) and project 15 (new psychiatric closed unit) have been terminated before completion with settlement agreements made. The contract amount for the two projects are R74.7 million and R50.6 million respectively. Completion of the new TB wards to be implemented under a new works information management system (WIMS) number. A completion contract that included alterations and additions of a new psychiatric closed unit has been implemented under a new WIMS number (035602) at an amount of R12.6 million. The contract has reached final completion but final accounts are however still to be finalised.

Project 13 (new crèche) at a contract amount of R3.1 million has reached practical completion, but final completion is still to be achieved.

Phase 4 comprised of two projects (16 and 17) and the construction period was scheduled for the period 01 April 2004 – 10 September 2008. Project 16 (upgrade of TB medical facilities) has been completed at a contract amount of R1.1 million.

  1. Committee findings and observations
    1. Financial performance
      1. Although the NHI Grant indirect portion was created partly to improve spending and performance on the NHI pilot projects, the direct grant had better spending performance in the financial years 2013/14 and 2014/15. This might be an indication that the Department of Health is having capacity constraints as compared to the provinces.
      2. The Department of Health relied more on spending donor funding for the NHI projects than the NHI Grant funds due to the fact that the Department found NHI Grant conditions inflexible.
      3. The poor spending in the grant is due to, among others, systemic and capacity challenges.
      4. Effective implementation of NHI pilots requires supplementary provincial equitable share funding, which provinces have not catered for.
      5. Some of the reasons advanced for the under-spending in NHI Grant are:
  • Supply chain management processes delays; and
  • Restrictive environment and lack of sufficient delegations at the district level as well as staff challenges at the district level.
    1. There is an urgent need to finalise the NHI policy framework so that the appropriate funding model can be determined.
    2. Although the Hospital Facility Revitalisation Grant spending is generally showing some improvement in some provinces, there are still spending challenges.
  • Non-financial performance
    1. Some pilot districts are struggling to attract health professionals with highly specialised skills.
  • Site visits
    1. Ngwelezane Hospital
      1. Some of the contractors that have been appointed could not deliver which implies that there are weaknesses in supply chain management processes especially the screening of suitable service providers.
      2. The delay in completion of some projects was due to lack of capacity by service providers as well as poor project design and planning.
      3. Having a fully operational hospital under construction has been a major challenge, especially on service delivery within the hospital. Construction activities, in some cases causing congestion, disrupt hospital operations that also impact on staff morale and create unfavourable health conditions.
      4. The construction of the three storey building project requires regular monitoring (by both the provincial department’s Infrastructure section and the Provincial Department of Public Works) to ensure that the quality of work is up to standard and the project is completed in time. Despite having the required CIBD rating the contractor is reportedly inexperienced for the kind of project under way. The pillars for the three storey building are very suspect and require a technical assessment.
    2. Edendale Hospital
      1. Delays in completion of some projects were due to poor project design and planning that led to changes during the construction stage as well as capacity constraints of some contractors. For example, certain items were either added, omitted or incorporated into other projects.
      2. Some of the information provided by consultants during project planning and design was found to be of poor quality that led to project changes during the construction stage.
      3. Having a fully operational hospital under construction has been a major challenge, especially with respect to service delivery within the hospital. Construction activities, in some cases causing congestion, disrupt hospital operations that also impact on staff morale and create unfavourable health conditions.
      4. With regard to the NHI pilot project the hospital is prioritising compliance with national core standards where it achieved a 81 percent compliance score. The current projects are part of the hospital’s attempt to ensure improved physical infrastructure for healthcare delivery, the hospital has district specialised teams in local communities and their client level activities are in place.
    3. King Dinuzulu Hospital
      1. Total expenditure from 1997 to July 2015 for all projects at the King Dinuzulu Hospital complex was R988.7 million of which R838.4 million was paid out to contractors and R150.2 million was paid out to consultants.
      2. Some of the outstanding projects were due for completion in 2008 and are still incomplete.
      3. Delay in completion of projects has the potential to compromise service delivery as well as lead to cost escalations.
      4. Some of the contractors that have been appointed could not deliver which implies that there are weaknesses in supply chain management processes especially the screening of suitable service providers.
      5. The delay in completion of some projects was due to lack of capacity by service providers as well as poor project design and planning.
      6. Having a fully operational hospital under construction has been a major challenge, especially with respect to service delivery within the hospital. Construction activities, in some cases causing congestion, disrupt hospital operations that also impact on staff morale and create unfavourable health conditions.
      7. The following need to be rectified – the TB surgical ward was to be handed over last year but this has not yet happened due to its non-compliance with regard to a fire prevention system; the stairway leading to the ground floor of the paediatric ward shows signs of leakage and cracks due to poor workmanship.

 

  1. Committee recommendations
    1. Financial
      1. There is an urgent need to review the appropriateness of certain conditions of the NHI Grant due to the fact that the Department prefers to utilise donor funds for the NHI projects because of what is seen as inflexible conditions of the Grant. Both National Treasury and the Department of Health should look into the matter and report back to the Committee before the 2016/17 financial year allocations are finalised.
      2. Provincial Treasuries should ensure that provinces also support the NHI pilot projects from their equitable shares. Provincial Treasuries should report back to the Committee on steps and measures put in place before the 2015/16 allocations are finalised.
      3. The Department of Health should finalise the NHI policy framework so that the appropriate funding model can be determined. The Department should report to the Committee on progress made within three months after the adoption of this Report by the House.
      4. Both National Treasury and the Department of Health should look into the systemic and capacity challenges as well as challenges in supply chain management processes that contribute to slow grant spending. The Office of the Chief Procurement Officer should report to the Committee within three months after adoption of this Report by the House on steps and measures put in place in this regard.
    2. Non-financial
      1. The Department of Health should monitor and support the pilot districts that are struggling to attract health professionals with highly specialised skills.
    3. Ngwelezane Hospital
      1. Both Provincial Treasury and the provincial Department of Health should develop measures and systems to screen suitability of contractors to deliver on infrastructure projects rather than using the construction industry development board (CIBD) rating only.
      2. The provincial Department of Health should on a regular basis monitor construction projects within fully operational hospitals to ensure that service delivery within the hospitals is not compromised.
      3. The provincial departments of Health and Public Works should on a regular basis monitor the construction of the three storey building project in Ngwelezane Hospital to ensure that the quality of work is up to standard and the project is completed on time.
      4. Both the provincial departments of Health and Public Works should, within three months after the adoption of this Report by the House, report to the Committee on the progress of all the outstanding projects that are still incomplete.
      5. The provincial Department of Public Works should, within three months after the adoption of this Report by the House, provide a technical report to the Committee on the state of the pillars of the three storey building as well as any precautionary measures put in place.
    4. Edendale Hospital
      1. Both Provincial Treasury and the provincial Department of Health should develop measures and systems to screen suitability of contractors to deliver on infrastructure projects other than using the construction industry development board (CIBD) rating.
      2. The provincial Department of Health should on a regular basis monitor construction projects within fully operational hospitals to ensure that service delivery within the hospitals is not compromised.
      3. The provincial Departments of Health and Public works should ensure that punitive measures are in place for consultants who provide insufficient/incorrect information during project design and planning.
      4. Both provincial Departments of Health and Public Works should, within three months after the adoption of this Report by the House, report to the Committee on the progress of all the projects that are still incomplete.
    5. King Dinuzulu Hospital
      1. Both Provincial Treasury and the provincial Department of Health should develop measures and systems to screen suitability of contractors to deliver on infrastructure projects rather than using the construction industry development board (CIBD) rating only.
      2. The provincial Department of Health should on a regular basis monitor construction projects within fully operational hospitals to ensure that service delivery within the hospitals is not compromised.
      3. The provincial Departments of Health and Public works should ensure that punitive measures are in place for consultants who provide insufficient/incorrect information during project design and planning.
      4. Both provincial Departments of Health and Public Works should, within three months after the adoption of this Report by the House, report to the Committee on the progress of all the projects that are still incomplete.
      5. Both provincial Departments of Health and Public Works should, within three months after the adoption of this Report by the House, report to the Committee on the progress with regard to the rectification of the TB surgical ward fire prevention system, and repairs done to the walls with poor plastering.

Report to be considered.

 

 

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