ATC160303: Report of the Portfolio Committee on Health on the Oversight visit to the Eastern Cape Province From 15 – 18 September 2015, dated 24 February 2016

Health

REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON THE OVERSIGHT VISIT TO THE EASTERN CAPE PROVINCE FROM 15 – 18 SEPTEMBER 2015, DATED 24 FEBRUARY 2016

 

The Portfolio Committee on Health, having conducted an oversight visit to the Eastern Cape Province from 15 – 18 September 2015, reports as follows: 

 

 

1. Objectives of the visit

 

One of the functions of the Portfolio Committee on Health is to conduct oversight of any executive organ of State falling within its portfolio. The Committee may also monitor, investigate, enquire into and make recommendations concerning any such executive organ of state.

 

The purpose of the oversight was therefore to assess the following in the public health facilities:

 

• Primary Health Care (PHC) services;
• Spending patterns of the province and the different health institutions;
• Human resources;
• Infrastructure in public health institutions;
• Balance between clinical and administration services;
• Health service delivery;
• Security in public health facilities; and
• Achievements and challenges in the National Health Insurance pilot sites.

 

1.  Delegation

 

Ms ML Dunjwa (ANC, Chairperson)

Mr AF Mahlalela (ANC) 

Dr P Maesela (ANC)

Mr I Mosala (ANC)

Ms CN Ndaba (ANC)

Dr HC Volmink (DA)

Mr AM Emam Shaik (NFP)

 

The following officials accompanied the delegation:

 

Ms Vuyokazi Majalamba (Committee Secretary)

Ms Nombali Magubane (Committee Assistant)

Ms Lindokuhle Ngomane (Content Advisor)

Mr Moses Mncwabe (Committee Researcher)

Mr Zubair Rahim (Committee Researcher)

 

 

 

 

1. Visited facilities

 

The Committee visited the following facilities in the Province:

 

• Bambisana District Hospital
• Port St Johns Community Health Centre (CHC)
• Tombo Clinic
• Maxhwele Clinic
• Nelson Mandela Academic Hospital
• Motherwell Community Health Centre
• New Brighton Clinic
• Kwazakhele Community Health Centre
• West End Clinic

 

 

1. Bambisana District Hospital (OR Tambo District)

 

The Committee met with the following officials and stakeholders:

 

Officials from the National Department of Health:

Mr Bennet Asia (NHI Policy Advisor)  

Mr NL Mudzononi (Manager)

 

Officials from the Bambisana Hospital:

Dr S Nokhangela (Acting Chief Executive Officer)

Mss L Van Zyl (Information Officer)

Ms Z Ramncwana (Administration Manager)

Mr TD Siyangaphi

NH Mkotana (Acting Nursing Manager)

Mrs N Somane-Mahlangeni (Assistant Manager Nursing: In-Patients)

Mr Philasande Mtheleli (Senior Manager: Finance and Supply Chain) 

Ms Thozama Mdontsane (Primary Health Care Supervisor)

Ms N Jwete (Area Manager: Maternity)

Mrs K Tom-Ntola (Operational Manager)

 Mrs NP Mahlamvu (Acting Quality Assurance Manager)

Ms NMR Msomi (Acting Infection Control Nurse: Office of Health Standards Compliance)

Mr OH Momangola (Area Manager: Theatre)

Mr S Mahlageni (Administration)

 

Officials from the District:

Mr TD Siyangaphi (Deputy Director)

Ms UN Bomela (Deputy Director: Human Resources)

Mrs PN Mgwili (Deputy Director: General Administration)

Mrs Nonceba Tetyana (Acting Sub-District Manager)

Mr GL Mafuna (Deputy Director: Supply Chain Management)

Mrs Z Fiki-Saliwa (Deputy Director: Finance)

Mr GN Ngcobo (Operations)

Ms VN Mnyaka (Acting District Manager)

Mrs BT Majola (Integrated Nutrition Programme Manager)

Ms JN Nqatyelwa (Acting Sub-District Manager)

Mrs ND Mayekiso (Sub-District Manager)

 

Board and Clinic Committee Members:

Mr G Tshotho (Chairperson of the Hospital Board)

Mr G Tubana (Secretary of the Clinical Committee)

Mr Greekson Thombela Zweni (Nkosi) (Board Member)

Mr M Tshongaye (Board Member)

 Mr M Dobe (Committee Member)

 Mr Z Mtiki (Board Member)

 

Hospital Chief Executive Officers (CEOs):

Mrs SN Sotsopo (CEO of Dr Malizo Mpehle Memorial Hospital)

Mrs Ms Vatiswa Vapi (CEO of Canzibe Hospital)

Mr Mluleki Dune (CEO of St Lucy’s Hospital)

Ms CN Zazela (CEO of Isilimela Hospital)

 

Mr R M Zweni (Ward Councillor)

Mr N Dyasi (Ward Council Member)

 

Ms N Nyathela (Parliamentary Officer in the Office of the MEC)

 

Ms NP Mqayi (Parliamentary Constituency Officer)

 

Dr Nokhangela (Acting CEO) made the presentation to the Committee and noted that Bambisana Hospital is a level one district hospital, built in 1962. The population served by the hospital is a low socio-economic population.  It has 134 beds with 120 usable beds. The hospital has nine feeder clinics. The hospital refer its patients to St Elizabeth Hospital, Nelson Mandela Academic Hospital and Bedford Hospital.

 

Services rendered at the hospital are maternity, obstetrics, medical and surgical, outpatient department services, pharmaceutical, radiology, laboratory, HCT, HIV/AIDS and trauma and emergency services.

 

On infrastructure, Dr Nokhangela informed the Committee that the facility’s main source of water supply is a spring and a borehole.  The water treatment plant is old and it needs to be upgraded. There are six security guards placed per shift, one at OPD, one at general and female wards and four are placed at the main gate. 

 

Dr Nokhangela highlighted the appointment of 20 employees in different categories, which is an achievement for the hospital.  He further noted that there is an ambulance that is stationed on site and that the hospital has a new telephone system.

 

 

 

 

 

 

 

The following were highlighted as challenges the hospital faces:

 

• Buildings and water piping system are dilapidated.  Roofs are leaking, floor tiles pilling off, walls are cracking and pilling off.  There are no pathways and no shelters.
• There is inadequate offices for administration personnel.  Wards are small and medical and surgical patients are treated under one roof.
• There is no accommodation for the hospital personnel.
• There is a dysfunctional borehole which is used as a backup system.
• Asbestos water pipes need to be upgraded.
• There are outstanding accruals and leave gratuities.
• There is a shortage of medical equipment.
• There is a shortage of clinical and administrative staff.

 

Mr Maqashiso, member of the hospital board, informed the Committee that there is a challenge regarding the rebuilding of Bambisana Hospital as they have been promised by the Provincial Department of Health that by the end of June 2015 the service provider will be on site but that has not happened. He further indicated that there was a huge water challenge at the hospital and sometimes they had to assist in transporting water to the hospital using their personal cars. He further noted that the borehole that was used for water was not in a good condition. The hospital has a challenge with electricity supply, the backup generator is not in a good condition. With regards to the filling of vacancies, Mr Maqashiso noted that it took long for the hospital to fill critical posts including that of the CEO which is also vacant.  He further indicated that sometimes staff work for seven months without being paid.

 

Mr Maqashiso further noted that there was no equipment in the hospital.  Ambulances used at the facility were not properly coordinated and they were privately owned. Mr Maqashiso pleaded with the Committee that oversight visits conducted must have an impact as they have been visited before by previous MECs for Health and previous Committees but there is no progress in improving the lives of the people who are using Bambisana Hospital. 

 

Findings made by the Committee:

 

Out Patients Department – there was overcrowding due to staff shortages. 

 

Paediatrics ward – the Committee noticed that the walls and the floor were peeling off. 

 

Maternity and labour ward – the hospital is utilising one ward as a receiving, delivery and labour ward. The labour ward is two bedded. The hospital reported that momConnect is not that active due to lack of connectivity and clients who do not own cellphones.

 

The Committee also noticed that there is no staff accommodation at the hospital, staff members stay in shacks and caravans.

 

 

 

1. Port St Johns Community Health Centre (OR Tambo District)

 

The Committee met with the following officials:

 

Officials from the National Department of Health:

Mr Moremi Nkosi (NHI Technical Advisor)

 

Officials from the CHC:

Mr NE Tshangana (Operations Manager)

Mr Xolile Vikilahle (Pharmacist)

Ms P Majakajaka (Professional Nurse)

Mrs T Gromo (Operations Manager)

 

Officials from the District:

Ms N Mdondolo (District Health Planning and Reporting)

Ms Z Fiki-Saliwa (Deputy Director: Finance)

 

Hospital CEO:

Ms CN Zazela (CEO of Isilimela Hospital)

 

Clinic Committee Members:

Ms M Zine (Clinic Committee)

Mr N Mvene (Clinic Committee Deputy Chairperson)

 

The CHC serves 13 surrounding villages. It is serviced by two full-time doctors and one community service doctor. There are 12 consulting rooms plus a theatre which is not operating.

 

The CHC reported the following challenges:

 

• Shortage of staff
• X-ray does not function as it is not licensed
• Leaking roof and toilet
• Shortage of staff accommodation
• Facility not accessible to the community, there is no public transport, patients and staff must walk from the town to get to the CHC

 

Issues raised by the Clinic Committee:

 

• The CHC was earmarked to be hospital, however there is no progress in this regard
• The CHC does not have a radiographer hence the X-ray licence has not been issued
• Concerned about safety of night shift staff as the boom gate does not work
• The CHC does not have a centre manager
• There is no on-site ambulance
• There is no diesel for the backup generator
• Staff members does not have nametags
• Clinic committee not compensated

 

Findings made by the Committee:

 

Pharmacy – the Committee noticed that medication was properly labelled in different shelves but there were space challenges as there had to keep all their medicines in one room. 

 

X-Ray room – the X-ray is not functional as it does not have a license.

 

The CHC has a new structure which was built for the 2010 FIFA World Cup. It has three consulting rooms, one short stay ward, drug storeroom, two wards (male and female, 6 beds each) and a theatre.

 

The older section of the facility was built in 1985. The centre has no kitchen for patients, as such there is never food to feed patients who are under 24-hour observation.

 

1. Tombo Community Health Centre (OR Tambo District)

 

The Committee met with the following officials, Chief, and Councillors:

 

Chief in attendance:

Mr Z Langa (Tombo Chief)

 

Officials from the CHC:

Ms NT Zuzani (Community Health Centre Manager)

Ms B Boqwana (Primary Health Centre Supervisor)

Ms PN Polase (Professional Nurse)

Ms S Selana (Professional Nurse)

Ms N Madolo (Enrolled Nurse)

Ms NNE Ndleleni (Professional Nursing Assistant0  

Ms NH Mnyamana (Enrolled Nursing Assistant ENA)

 

Official from the District:

Mr SSS Mlenzana (District NHI Coordinator)

 

Mr NB Mtuku (Ward Councillor)

Ms T Nompaka (Ward Councillor)

 

Ms Zuzani made the presentation to the Committee and noted that Tombo is under Port St Johns Local Municipality under Nyandeni Sub-District and situated on the R61 road to Port St Johns.  The centre is serving a catchment area of 13 villages and a population of 20 547. It has four feeder clinics namely; Ludalasi, Mantusini, Caguba and Majola.  The centre refers to Isilimela Hospital.

 

The disease profile includes; HIV and AIDS, Tuberculosis, sexually transmitted infections (STI’s), hypertension, diabetes, epilepsy and mental health.

 

The centre renders primary health care package which consist of health promotion services, child and maternal health care services including antenatal care and deliveries and all chronic care.

 

On infrastructure, Ms Zuzani noted that the facility has three consulting rooms and a modular structure that is in the pipeline and the contractor is on site. 

 

Ms Zuzani further noted that there is a doctor on site that has been contracted under the National Health Insurance Grant.

 

On challenges, Ms Zuzani mentioned that there was no backup generator and were only using paraffin lamps and torches during load shedding, however an order for a generator has been submitted.

 

Ms Nompaka (Ward Councillor) highlighted some of the challenges the health centre is facing. She noted that there was not enough space at the facility and this is attributed to the fact that all rural areas surrounding Tombo that are supposed to have their own health facilities come to Tombo CHC for health services.  Consulting rooms are not enough to cater for the vast number of people that are coming to the health centre.  Ms Nompaka noted that there was a huge shortage of staff especially nursing personnel for night shifts. There is also a shortage of ambulances and drivers, thus at times the health centre has to get an ambulance from Mthatha. Ms Nompaka further highlighted that on occasion the health centre is faced with a shortage of drugs as there is no transport dedicated to the facility for the transportation of drugs. 

 

1. Maxhwele Clinic (OR Tambo District)

 

On the 16 September 2015, the Committee visited Mxhwele Clinic. At the facility, the Committee met with the following officials and Clinic Committee:

 

Officials from the National Department of Health:

Mr Moremi Nkosi (NHI Technical Advisor)

Mr B Asia (NHI Policy)

 

Officials from the Clinic:

Ms L Mavuswana (Operations Manager)

Mrs PN Tafa (Primary Health Care Supervisor)

Ms N Mgwili (General Administrator)    

 

Officials from the district:

Mrs NE Mafele (Acting Sub-District Manager)

Dr P Maduna (Deputy Director General)

Mr SSS Mlenzana (NHI Coordinator)

Mrs NP Tetyana (Acting Sub-District Manager)

Ms JN Nqatyelwa (Acting Sub-District Manager)

Mrs EN Matebese

 

Official from the Office of the MEC:

Ms N Nyatela – Parliamentary officer in the Office of the MEC

 

Hospital CEOs:

Mrs NE Matebese (CEO of Zithulele Hospital)

Ms CN Zazela (Hospital CEO of Isilimela Hospital)

Mrs NS Sotsopo (Hospital CEO of Dr Malizo Mpehle Memorial Hospital)

 

Clinic Committee Members:

Ms E Mhlakaza

Mr Luvuyo Jezile

Ms Iris Mlanjeni

 

Miss L Mavuswana (Operations Manager) briefed the Committee and noted that Maxhwele Clinic is a small clinic serving a population of about 4000. It was built in 1998 by members of the community. There are two consulting rooms. Some of the challenges highlighted includes, delays in the delivery of medicines, there is no backup generator, long response times for an ambulance and the lack of space. With regards to ward-based outreach teams (WBOTs), there are four community health workers with no team leader.

 

An Ideal clinic is being built. The contractor is currently on site. The Committee was taken on a tour in the construction site adjacent the old building. While Committee members were encouraged by certain aspects of the development, they did raise concerns which included the question of accessibility of the clinic site.

 

1. Nelson Mandela Academic Hospital (OR Tambo District)

 

On 16 September 2015, the Committee visited Nelson Mandela Academic Hospital and met with the following officials and hospital board members:

 

Officials from the hospital:

Mrs NP Makwedini (CEO of Nelson Mandela Academic Hospital)

Dr TM Madiba (Director: Clinical)

Mrs Victoria Zoleka Beja (Manager: Quality Assurance)

Mrs Nonkosi A Rasmeni (Deputy Manager: Nursing)

Mrs Thandekile Matshoba (Deputy Manager: Nursing)

Mrs Ncediwe Nongawuza (Manager: Pharmaceutical Services)

Ms Nombulelo E Matyolo (Manager: Nursing)

Mr E Venter (Head: Facilities)

Mr Teboho J Matsela (Deputy Director: Assets and Inventory)

Ms A Mjali (Deputy Manager: Inpatients)

Mr TS Ngxekese (Director: Human Resource and General Administration)

Dr ML Matiwane (Chief Director: Hospital Services)

Dr PH Madwa (Deputy Director General)

Mrs NS Booi (Deputy Director: Human Resource Development)

Mrs T Tubase (Deputy Director: Labour Relations)

Mrs RN Nondoda (Deputy Director: Planning, Monitoring and Evaluation)

 

Board Members in attendance:

Advocate PV Msiwa (Chairperson of the Board)

Reverend MS Kuse (Board Member)

 

Mrs Makwedini (CEO) briefed the Committee and noted that Nelson Mandela Academic Hospital services a population of 2.5 million. On achievements, Mrs Makwedini noted that as a central hospital, the facility has produced paediatric specialists and obstetrics and gynaecologists. The hospital is also in a process of constructing a maternity wing with subsequent opening of 23 beds to decongest the long overcrowded unit. 

 

On challenges, Mrs Makwedini highlighted overcrowding in the neonatal unit, ineffective referral system and challenges in the management of orthopaedic unit which is 9 kilometres away from the main hospital.  The lack of an approved organogram for the hospital since it has been gazetted as a central hospital presents a challenge.  Staff shortages in all categories especially after decomplexing and insufficient budget for a central hospital. 

 

Advocate Msiwa (Chairperson of the Hospital Board) briefed the Committee and highlighted some of the challenges the hospital is facing. He indicated that the hospital was classified as a tertiary hospital but the budget allocated to the hospital is not enough to run a tertiary hospital. He informed the Committee that the hospital was understaffed particularly on support personnel due to a moratorium on employment of support staff.  Advocate Msiwa further noted the dilapidated infrastructure and the fact that there was no maintenance budget. 

 

Advocate Msiwa informed the Committee that the facility was faced with litigations due to medical negligence which also depletes the hospital’s budget. The issue of outsourced services such as catering and cleaning was also raised as a challenge for the hospital. Advocate Msiwa further informed the Committee that there was lack of communication between the Board, the office of the MEC and the Head of the Department. 

 

Findings made by the Committee:

 

Female medical ward – the Committee observed that medicines in the treatment room were not properly labelled. 

 

Out patients department – overcrowding was noted and when asked about how long they have to wait to be attended to, patients indicated that they wait approximately five to six hours. Dr Mthembu informed the Committee that the overcrowding was due to the fact that the hospital services all areas and as far as Mbizana.  He further noted that the situation can be improved if facilities around Nelson Mandela Academic Hospital can be better resourced with personnel (nurses and doctors) and equipment. 

 

Maternity ward – the Committee was informed that there is a dire shortage of maternity beds. It was noted that the obstetric ambulance is not only dedicated for maternity issues and is sometimes used to attend to other cases which are not maternity related. The doctor in charge of the maternity ward mentioned that the situation can be improved if the referral system can be reviewed and patients get referred to the nearest facility even if it is not in the same province. 

 

Nursery – the Committee noticed that there was a severe shortage of incubators and in some cases three babies were sharing one incubator. This was a serious concern to the Committee as this can cause cross infections. 

 

One stop service centre for ex-mine workers – approximately 20 to 25 ex-miners are attended to at the centre. Consultation includes screening for occupational health diseases and submitting claims to the Medical Bureau of Occupational Diseases. The Committee noticed that there were no patients seeking services on the day of the visit.

 

Pharmacy – the Committee noted that labelling is not properly done.  Drug availability was at 70%. There is understaffing at dispensary, patients wait long period of time for their medicines. There is a shortage of pharmacists and pharmacy assistants. There is a need for an electronic queuing system.

 

Allied services – the hospital is the only one in Mthatha that offers dermatology and ENT (ear, nose and throat) services. Because of the poor referral system, there is overcrowding and long waiting times. The X-ray machine has not been working for four months. Equipment maintenance is on a quotation basis.

 

Laundry – it has a staff complement of 58, of which nine are departmental staff and 49 service provider staff. Departmental staff last received protective clothing in 2013 and there is no contract in place for protective clothing. Only one ironing machine and it does not function properly.

 

 

1. Motherwell Community Health Centre (Nelson Mandela Bay Metro)

 

On 17 September 2015, the Committee visited Motherwell Community Health Centre.  The Committee met with the following officials and members of the Clinic Committee:

 

Officials from the CHC:

Ms Phumla Njalo (Facility Manager)

Ms A Jacobs (Acting Clinic Supervisor)

Mr A Messiahs (Acting Nutrition Coordinator)

Mr Ntsikelelo Dodi (Station Manager)

Mr A Botha (Emergency Services)

Mr M Kolele (General Administration Manager)

Mrs Brenda Lupuwana (Primary Health Care Manager)

Mrs Buyelwa Tenge (Trauma Operational Manager)

Mrs Zukiswa Mwanda (HIV/AIDS Manager)

Mrs Zukisa Mcopela (Acting Clinic Supervisor)

Mrs Pumla Qupe (Operations Manager: Outreach Services)

Miss Lindiwe Nondzube (Clinic Supervisor)

Dr Mbasa Mayekiso (Clinical Manager)

Ms NE Ngxovu

 

 

 

Officials from the District:

Mrs BA Suceyers (Deputy Director: District Health Planning and Reporting)

Mrs SO Msutu (Sub-District Coordinator)

Mrs MD Manuel (Deputy Director: Clinical Support Services)

Mrs N Van der Bergh (Deputy Director)

Mr Mzoli S Njalo (Human Resource and Administration Director)

Dr SM Blignault (Sub-District Pharmacist)

Mr B Metune (Emergency Medical Services District Manager)

Miss Lifukazi Ngcwangu (District Laboratory Services)

Mr Teneitte Campbell (District Rehabilitation Services)

Mr Jerold Baartman (Infrastructure Assistant Director)

 

Clinic Committee Members in attendance:

Mr Pakiso Sefalani (Clinic Committee Organiser)

Mr Ayanda Mredlana (Clinic Committee Treasury)

 

Ms Njalo (Facility Manager) briefed the Committee and noted that Motherwell CHC was established in 1987. It services a population of about 8000.  The population has since increased tremendously and there has never been any buildings or extensions to the CHC since it was established, in spite of the continuous growth in population and health programmes.  The CHC is a fully fledged facility which is servicing six cluster clinics, including Colchester. This has put tremendous pressure on limited human resource capital and infrastructure (equipment and availability of space).  The CHC is the only facility that operates 24 hours, seven days a week and on public holidays. The facility qualifies as an Ideal clinic.

 

The facility has functional and active governance structures such as community health committee, community health forum and head of departments forum. The facility is also providing outreach services which include family planning, cervical cancer screening, immunization, tuberculosis screening and testing, health education, HIV counselling and testing, tracing of postnatal cases, distribution of condoms, tracing of ARV and TB defaulters.  The facility manager also highlighted the facility also provides school health services.

 

The following were highlighted as achievements:

 

• Renovation of the entire facility which were done in 2013.
• There are five ambulances on site.
• The facility has retained baby friendly status for three consecutive years since 2013.
• Health teams (clinical and non-clinical) are actively involved in the continuous monitoring of the dashboard indicators.
• The facility is a pilot site for multiple screening of pregnancy, TB, STI and NCD’s.  Positive pregnancy tests are immediately referred to ANC for 1st ANC booking to boost the priority indicator of ANC 1st visits in 20 weeks.
• Facility has identified champion nurses who are passionate with each service programme and are empowered through ongoing updates and workshop to enhance their knowledge and management of the programme.
• Clients are continuously encouraged and counselled to take ownership of their own health.
• Waiting times are monitored using a tool extracted from the Ideal Clinic Manual and the average waiting time is approximately two hours.
• To avoid drug stock outs, the centre is sharing resources with feeder clinics for medicines and supplies.
• The facility uses a booking system for ANC visits and ARVs collection to deal with waiting times.
• The facility has also received three casualty trolleys from general stores.

 

Ms Njalo informed the Committee that security services are outsourced.  There are three security guards per shift in a 12 hourly shift.  She further noted that security coverage is not enough especially during weekends and public holidays due to community violence that impact on staff safety, however the facility is awaiting installation of CCTV cameras.

 

The following are challenges faced by Motherwell CHC:

 

• The building is the same size since 1987 and is not coping with the increasing population.
• There is poor ventilation in areas like outpatient department and casualty which poses a threat of cross infection to staff members and clients due to increasing TB/MDR/XDR.
• The budget for the facility is centralised.
• There is only one maternity delivery bed and patient chairs are broken and have not been replaced due to non-availability of capital budget.
• The facility is operating on an old organogram and this has led to staff shortages especially pharmacist post and nursing staff.
• The facility does not have an autoclave for sterilisation of surgical and maternity packs.
• There is poor quality of cleaning material in high traffic areas
• There file stock outs from the main stores which hampers the retention of files.
• Emails are not working most of the time.
• X-ray machine cannot transfer x-rays to the old computers, doctors have to use their cell phones.
• Patient chairs and maternity delivery beds are not enough.
• Waiting time for clinical assessment is a challenge, which can be up to seven hours.

 

Findings made by the Committee:

 

Dental unit – dentures are a major challenge for the unit and there is no budget to maintain the equipment. The unit is in partnership with the Department of Correctional Services for outreach services. 

 

Emergency medical services unit – there are five functional ambulances that are based at the centre. There is also a dedicated maternal ambulance. The unit’s telephones are linked to hospitals and police stations to improve response times.

 

 

1. Kwazakhele Community Health Centre (Nelson Mandela Bay Metro)

 

The Committee met with the following officials at the centre:

 

Mr Siphiwo Mtshayi (Middle Manager)

Mrs Bekiwe Giyana (Deputy Director: Quality Assurance)

Mrs Siyanda Macingwane (Director for Finance and Supply Chain Management)

Miss Labase Nondze (Operational Manager)

Mrs Nompucuko Ngwevela (Nursing Service Manager)

Mrs Zukiswa Mwanda (HIV/AIDS Programme Manager)

Mrs Siphiwokazi Msutu (Sub-District Coordinator)

 

Mr Rufalo Mfundo Chimarilo – Clinic Committee Member.

 

Mr Mtshayi (Middle Manager) briefed the Committee and noted that Kwazakhele Community Health Centre is located at Mavuso Road in the township of Kwazakhele. The official opening of the centre was on 11 November 1974.  The facility was meant to be a temporary structure with a capacity to accommodate about 500 patients per month.  This was meant to alleviate congestion and pressure at Livingstone Hospital.

 

The current catchment population is approximately 45 000 according to the District Health Information System (DHIS) population estimates.  The socio-economic profile is characterized by high levels of unemployment and a burden of disease marked by high levels of TB, HIV/AIDS, STIs and substance abuse. Teenage pregnancy although not alarming, still require constant monitoring as figures fluctuate from month to month.

 

As the population increased over the years, so did the demand for more services to be added to the existing package. Though not providing a comprehensive PHC package, the facility eventually acquired a Community Health Centre status.  The Kwazakhele Midwife Obstetric Unit (MOU) opened in August 2009, and has since been the busiest in the Metro with average monthly statistics of 160 deliveries. The MOU is located in Dora Nginza Hospital and the desire is to move it to Kwazakhele CHC and that all the other unavailable services will soon be added to the benefit of the catchment population on a 24-hour and seven days week basis. 

 

The facility is providing full PHC package except for the lack of a trauma unit, radiology, dental care, rehabilitation services and choice of termination of pregnancy. 

 

On human resources, Mr Mtshayi informed the Committee that some posts that become vacant are lost as a result of the baseline policy even though motivation for filling of the posts (operational manager outreach services and school nurse) are done and submitted timeously.

 

Mr Mtshayi highlighted that the budget is centrally controlled at the district and thus far it appears to be working. The facility seldom run out of stock except in cases where the item/s are not available at the Medical Depot. 

 

 

 

The following are challenges faced by Kwazakhele CHC:

 

• Infrastructure challenges limit the facility from being a fully-fledged CHC which provides the full package of PHC services
• The 29 consulting rooms are not enough to deal with caseload
• The consulting rooms are too small
• Privacy in some consulting rooms is compromised because of the layout in the building
• There is no groundsman at the facility, the grounds of the facility are not being maintained
• Unused containers were lying around the facility, this may pose health hazards

 

Findings made by the Committee:

 

The Committee had a walkabout and commended the cleanliness of the facility.  The Committee further noticed that in one of the consulting rooms there was no proper filing, medication was mixed with scissors in a stationery box and it was not properly labelled.

 

1. New Brighton Clinic (Nelson Mandela Bay Metro)

 

The Committee met with the following officials and Clinic Committee members:

 

Officials from the Clinic:

Mr Lester Coleman (Operational Manager)

Miss Tobela W Mngqibisa (Community Health Nurse)

Mrs Nomakhosaza G Vuyelwa (Community Health Nurse)

Ms ND Zita (Professional Nurse)

Mrs A Marcus (Professional Nurse)

 

Clinic Committee Members in attendance:

Mr Mkrotso Fololo

Mr Gallo Mbebeto

Mr Rufalo Mfundo Chimarilo

 

Mr Coleman (Operational Manager) briefed the Committee and noted that the catchment population that is serviced by the facility is 29 661 with a total headcount of 25 340. The professional nurse workload is 1:35 and the doctor workload is 1:42.

 

Services rendered at the facility includes non-communicable diseases chronic care, communicable diseases, HIV/AIDS, acute care, baby services, antenatal care, postnatal care, cervical cancer screening, contraceptive services and dental services.

 

The following were indicated as achievements for the facility:

 

• There is monthly monitoring of dashboard indicators.
• Improvement plans are done and implemented to improve dashboard indicators.
• There is an improved initiation on ART of TB/HIV co-infected clients from 50% to 100%.
• There is an improvement in antenatal care (ANC) first visits under 20 weeks from 37% to 82% in quarter two.
• There is improved exclusive breastfeeding at 14 weeks from 40% to 95% in quarter three.
• There is monitoring of viral load at correct time periods.

 

The following are challenges faced by New Brighton Clinic:

 

• Low antenatal care visit bookings under 20 weeks
• Mothers not breastfeeding after 14 weeks
• Low HIV counselling and testing
• Low condom distribution rate
• Decline in fully immunised under one year rate
• Low couple year protection rate (contraception)
• Shortages of staff in all categories, cleaners, nursing staff, administrative support staff, facility manager and pharmacy staff.
• There is lag time in the tender process leading to no service being rendered such as grass cutting and she-bins.
• Lack of transport leading to delays in deliveries
• Infrastructure repairs and maintenance being delayed due to lack of funds
• Delay in routine maintenance and replacing equipment which cannot be repaired
• Delay in attending to and resolving IT issues like computers, telephones and connectivity

 

Mr Coleman informed the Committee that the facility was faced with safety issues which puts the life of staff and patients at risk. 

 

The Clinic Committee highlighted the following as serious security challenges:

 

• There are frequent burglaries at night
• There was stabbing of a community member inside the clinic and staff member’s bag taken at gunpoint
• Staff car broken into and laptop stolen
• Fights among clients inside the clinic premises
• More recent incidents of fight among husband and wife inside the clinic, staff member cellphone stolen and assault of staff member

 

Mr Mbembeto (clinic committee member) informed the Committee that as clinic committee members they are not getting a stipend and have been working in the clinic for 12 years and that one committee member has since passed on without getting the stipend.  He further indicated that they struggle with transport to attend meetings. They further requested that there is a need for the clinic to be converted to a 24-hour service facility with three doctors, two managers, a pharmacist and the issue of staff shortages be addressed. Mr Mbembeto further requested that clinic committee members should have name tags. 

 

One nursing staff highlighted some of their frustrations as health workers of the clinic.  Issues includes the lack of a pharmacist to dispense and properly store medicine. These leads to nurses having to split their time between clinical assessments and dispensing medicine and this impacts on waiting time.  Other issues pertains to pronvincialisation that was implemented, some health workers who were transferred as primary health care specialists for training ended up being downgraded to general nurses.

 

1. West End Clinic (Nelson Mandela Bay Metro)

 

The Committee conducted an oversight visit at West End Clinic MOU and met the following officials:

 

Sister N Prins (Acting Operational Manager)

Sister V Nel (Professional Nurse)

Sister M Blignaut (Professional Nurse)

Sister B Francis (Acting Facility Manager)

Mrs MY Koll (Acting Sub-District Coordinator)

 

Sister Francis (Acting Facility Manager) informed the Committee that they deliver about 136 babies a month and keep mothers for 12 hours for observation.  They have three advanced midwives and a dedicated obstetric ambulance. The response time for ambulance is about two hours.

 

Some of the successes highlighted are; zero maternal deaths since its opening in 1998, zero stillborn babies in the last 13 months, and three advanced midwives trained and practicing in the unit.

 

Challenges highlighted includes; insufficient linen when it is busy, an urgent need for a new CTG (cardiotocography) machine, and insufficient delivery and postnatal beds.

 

 

1. Overall findings and observations made by the Committee

 

The Committee made the following findings and observations:

 

1. Human resources

The provincial department suffers from critical staff shortages in all staff categories. The high vacancy rate can also be attributed to a moratorium on the filling of vacant posts, particularly employment of support staff. Funded vacancies takes time to be filled. Nelson Mandela Academic Hospital was upgraded into a tertiary hospital, however, it is still operating under the old organogram and this puts pressure on the facility in delivering tertiary level services.

 

1. Finances

Insufficient operating budget was found to be a challenge in all the facilities visited.  Some facilities reported that they experience procurement delays owing to the centralised budget. Lack of maintenance budget is a challenge in all facilities visited.

 

 

1. Infrastructure

Staff accommodation was found to be in dire straits particularly in Bambisana Hospital, where staff stays in shacks and caravans. Bambisana Hospital was prioritised to be re-built in 2014, however there is no progress in this regard. Most facilities visited does not have backup generators, they resort to candles during load shedding.

 

Clinical equipment is a challenge in all facilities, ranging from lack of incubators (Nelson Mandela Academic Hospital), X-ray machine not compatible with old computers (Motherwell CHC), broken CTG machine (West End MOU), and lack of an autoclave (Motherwell CHC).

 

Facilities that does have laundry services on-site, the laundry equipment are not in good condition. Some facilities reported a shortage of maternity beds and patient chairs.

 

1. Governance structures

Governance structures exist in most facilities visited. However, members of these structures are aggrieved on that they are not offered a stipend and/or sitting allowance and issues related to a lack of communication between the committees and officials.

 

1. Emergency Medical Services

There is a shortage of ambulances. Response time remains a challenge in most facilities. An ideal EMS model was found in Motherwell CHC.

 

1. Waiting time

Long waiting times remains a challenge, with patients having to wait up to seven hours.

 

1. Referral system

Referral systems does not seem to be effective, this impacts negatively on caseload and waiting times. 

 

1. Safety

In New Brighton Clinic, the safety of patients and staff members is a serious concern.

 

 

1. Recommendations

 

In response to the findings and observations, the Committee recommends that the provincial department should:

 

• Address the issue of staff shortages urgently, as this was identified in all health facilities visited.
• Prioritise the filling of all critical posts.
• Fast track the review of the organogram of Nelson Mandela Academic Hospital.
• Ensure that a budget need assessment is carried out and budget anomalies looked into to ensure that health facilities have sufficient budget allocations.

• Prioritise infrastructure funding to ensure that all infrastructure and clinical equipment challenges are addressed.
• Ensure that health facilities have relevant equipment and equipment maintenance plans are in place.
• Prioritise the construction of Bambisana Hospital. This project should also address the issue of staff accommodation. The provincial department should provide the Committee with a progress report in this regard.

• Address the issue of insufficient ambulances and improve on response times.
• Devise practical methods (i.e. queues administration) to reduce waiting times.
• Strengthen the referral system and adherence to referral guidelines aligned with the re-engineering of primary health care.
• Prioritise security measures in New Brighton Clinic to ensure the safety of patients and staff.
• Ensure that there is wide awareness of momConnect and that expectant mothers are registered.

 

Report to be considered.