ATC160303: Report of the Portfolio Committee on Health on the Oversight visit to the Free State Province on the 19 June 2015, dated 24 February 2016
REPORT OF THE PORTFOLIO COMMITTEE ON HEALTH ON THE OVERSIGHT VISIT TO THE FREE STATE PROVINCE ON THE 19 JUNE 2015, DATED 24 FEBRUARY 2016
The Portfolio Committee on Health, having conducted an oversight visit in the Free State Province on 19th of June 2015, reports as follows:
Ms ML Dunjwa (ANC, Chairperson of the Committee)
Ms Ncube-Ndaba (ANC)
Ms MA Scheepers (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)
- Objectives of the visit
The basic pillar of any public health system is the supply of medicines in clinics and hospitals. The Committee therefore conducted its oversight visit to assess the availability of medicines in the Free State Province.
- Visited facilities
The Committee visited the following facilities in the Province:
- Ikgomotseng Clinic
- Medical Depot
- Pelonomi Hospital
- Oversight at Ikgomotseng Clinic
The Committee met with the following health professionals at the clinic:
Ms ME Monnye (Acting District Manager); Ms MD Moletsane (Acting Local Area Manager); Ms SI Mochoane (Operational Manager); Dr Pule Matjoa (Advisor to the MEC); and Mr Teboho Oepeng (Parliamentary Officer in the Office of the MEC).
Ms Monnye made the presentation to the Committee and noted that Ikgomotseng clinic is one of the primary health care (PHC) facilities situated in Soutpan Town of Masilonyana Sub-District under Lejweleputswa Health District. The clinic is operating eight hours, five days a week. There are only two consulting rooms at the clinic.
The clinic is servicing a catchment population of 5 616 according to the 2011 Census and the DHIS 2014 mid-term estimates. According to the demarcation, the distance walked by the community is 5 about kilometre, which means it is accessible to the community.
Ms Monnye highlighted the following as challenges faced by the clinic:
- The pharmacy is very small and not meeting prescribed standards.
- There is not enough space to accommodate the volume of the medicines.
- The waiting area is also very small.
- There are only two toilets in the facility and one is leaking but a request to fix it has been submitted.
- The clinic is sharing a park home with Emergency Medical Services (EMS).
4.1 Walkabout at the clinic
The Committee took a walkabout in the clinic and noted that the waiting area is congested with adults and children in the same area. The Committee also noticed that there were no proper patient files and there is no space to keep records.
The facility has no dedicated dental surgery but there is a dentist that comes once a month. The Committee observed that the facility was kept clean even though there is only one cleaner.
The main challenges at the pharmacy include the shortage of staff, it is operated by a pharmacy assistant; limited space to keep buffer stock; the pharmacy is not secured, it is easily accessible; and there is no electronic system for capturing stock. In terms of drug shortages, there was only one vile of BCG left, low stock of Nevarapine and lack of diabetes drugs (Diamicron).
Community health workers complained that they were not paid on time by the non-governmental organisation (NGO) that has employed them and they have not received any training since 2014.
The Committee engaged the patients and they informed the Committee that the clinic is too small and is unable to accommodate the entire community. The community was also concerned about the waiting area which is congested. A patient indicated that she is suffering from MDR-TB but she is in the same waiting area with other patients and children.
Some patients indicated that sometimes they do not get their chronic medication and have to come back another time. Patients further complained that it takes up to six hours to get an ambulance. They further complained that referred patients sometimes have to wait outside the facility from 4:00 am whilst the clinic start operating at 08:00 am, even in bad weather and when it is still dark which puts them at danger. Patients also indicated that they were not connected to momConnect and were not aware of momConnect.
- Meeting with the MEC for Health
The Committee met with the following officials at the office of the MEC:
Dr B Malakoane (MEC for Health in Free State Province); Dr D Motau (Head of Department); Dr Balakzela Mzangwa (Chief Operations Officer); Dr PM Molokomme (Chief Executive Officer at Pelonomi Hospital); Mrs B Molongoane (Director: Pharmaceutical Services); and Mr AL Phetho (Deputy Director: Financial Management).
Having concluded the oversight visit at Ikgomotseng Clinic, the Committee met with the MEC. The Committee briefed the MEC on their observations. In response to these observations, the MEC indicated that he agreed with all the observations and noted with concern that Lejweleputswa District is a failing district and the majority of issues are administrative failures. The MEC indicated that he had given a directive to the Chief Operations Officer to address the issues in Lejweleputswa District. The MEC mentioned that he believes that there are warm bodies occupying positions with no evidence of people who are actually doing the work.
On the issue of training of community health workers, the MEC indicated that they have approved a training programme for community health workers to be trained by the department over a period of one year at the regional training centre which is based in Pelonomi.
The MEC informed the Committee that there are 221 clinics in the province and majority of these clinics are not coping with the volumes of patients seeking health services as the province is experiencing an influx of patients from neighbouring provinces such as the Eastern Cape, Northern Cape, North West as well as Lesotho. They have a programme that needs to be funded for the extension of clinics. The department has built eight clinics in areas where they felt there were pressures and that Ikgomotseng Clinic’s infrastructure issues will also be addressed. He further noted that the department has managed to build clinics in six weeks using a containerised system and that Ikgomotseng Clinic is also considered for that system and it will then be able to accommodate 120 patients.
The MEC further indicated that laundry services are organised in such a way that hospitals are prioritised. An ideal plan is that clinics should have washing machines so that they are able to do their own laundry without having to take it to other facilities. On cleanliness, the MEC indicated that the department was doing its best to ensure that facilities are clean at all times.
The MEC was concerned that the community was not aware of momConnect whilst the project was launched in the Free State Province in 2014. On school health programme and HPV vaccination, the MEC mentioned that he has not had an opportunity to observe and make an assessment in that sub-district, however doubts if these programmes are doing well.
On drug shortages, the MEC indicated that the Free State Province has been in the media since 2013. The department has never denied the fact that there were certain medicines they did not have and have acknowledged that there are many factors that contributes towards drug shortages. Firstly, simple clumsiness and ineptitude of clinic staff. Secondly, supplier failure which has a negative impact on health service provision. For example, the manufacturer of BCG which is a French company did not have stock. The biggest challenge they have as various provincial Departments of Health is to consider what options are there, who else manufactures BCG and a manufacturer who is not contracted but is able to produce BCG.
The MEC indicated that when he joined the department in 2013, there was an absence of Amlodipine a type of calcium channel blockers. Amlodipine was unavailable because of supplier problems and the Free State was in the media when it was also not there in other provinces. The department learned that the manufacturer has stopped producing Amlodipine and the option they had was to use other more expensive calcium channel blockers. Furthermore, Abacavir has been out of stock for two years and so it was not a discovery that was made two weeks ago and it was due to supplier failure, however the media portrayed it as if it is a new discovery.
The MEC mentioned that the absence of basic drugs like Panado was a supplier failure whereby a supplier will not come forth right and indicate their inability to supply the drugs. If a supplier is failing to supply, buy out is not an option because buying out is usually at a higher cost than the normal cost of the same drugs. Tracer drugs or the essential drug list is designed in such a manner that every facility must have the basics but if there are no antibiotics it means that they do not have the most basic drugs. Suppliers will complain that they have not been paid over 30 days and therefore they are putting the account on hold until they are paid. After they have been paid, they are still unable to supply the drugs and will require six weeks before they can deliver.
The nature of service providers who are unable to produce drugs was a concern and the kind of vetting process they go through before contracting. The MEC indicated that he was not putting the blame only on suppliers but managers as well. As managers are aware that they need to monitor the consumption and ordering of drugs so as to avoid drug shortages at any point in time. In his conclusion, the MEC mentioned that there is a need to improve the supply and availability of drugs to patients as this leads to challenges of non-adherence to treatment and resistance to drugs.
- Oversight at the Medical Depot
The Committee met with Mr Charles Geef and Mrs B Molongoana at the Medical Depot.
The Committee was briefed by Mr Charles Geef who outlined to the Committee the process of ordering medicines and the process followed when the medicine reach the Medical Depot. He informed the Committee that the Medical Depot is responsible for the procurement, management, storage and distribution of pharmaceuticals, medical consumables and medical stationery to health care institutions in the Free State Province.
On distribution, Mr Geef informed the Committee that the Medical Depot needs to ensure that arrangements are in place for safe and secure distribution of stock to facilities. All deliveries must be accompanied by a dispatch voucher and the relevant issue vouchers and that all items on a dispatch voucher must be delivered as a single consignment.
He indicated that they had staff shortages at the Medical Depot and that they were using national suppliers. He mentioned that they do not have a full trail of checking expiry date and that medicines that will expire in six months are accompanied by a letter indicating that the facility will have to use these drugs within before the expiry date. They have outsourced a contractor that disposes of expired drugs.
He further indicated that they were operating as a trading account and were charging levies from facilities. The challenge was that the levy has not gone up for the past ten years and they were in a process of evaluating the placement of the Medical Depot, whether it should remain as a trading entity or under a sub-directorate in the department.
The Committee took a walkabout at the Medical Depot and noticed that there were large volumes of HIV treatment on stock.
- Oversight at Pelonomi Hospital
The Committee met the following officials at the hospital:
Mr IP Lethetsa (Acting Head Nursing); Ms A Stofile (Deputy Director: Financial Management); Dr FA Gebremariam (Acting Head: Clinical Services); and Mr LA Khiba (Deputy Director: Technical Services).
The CEO of the hospital Dr Molokomme indicated that they have not experienced any drug stock outs in 2015. The Committee took a walkabout at the hospital and visited the orthopaedic female and male wards, labour ward and the children ward. In all visited wards, the Committee engaged the patients who indicated that they were taken care of in terms of treatment and food.
The Committee visited the archives and was briefed by a data capturer who indicated that she has been working in the hospital since 2004. She indicated that they were attending about 400 patients a day except for follow-ups. They also have a teenage programme where teenagers come and they are attended to in terms of teenage issues.
- Findings by the Committee
- Ikgomotseng Clinic
- The pharmacy is small, lack security measures and short staffed. There is only one pharmacy assistant who dispenses medicine with the nursing staff having to dispense medicine when the pharmacy assistant is on leave and this was a concern to the Committee.
- Due to the size of the pharmacy, the facility is unable to order bulk stock.
- There are insufficient number of nursing personnel, cleaners, groundsman, clerk and pharmacist. The facility relies on prisoners for cleaning the facility grounds
- The community was not aware of momConnect and were not registered.
- The clinic is very small and there is congestion in the waiting area.
- There is no emergency medical services that is stationed at the clinic. This leads to long waiting times for an ambulance.
- Community health workers complained that they were not paid on time and have not been to any training since 2014.
- The facility does not have security personnel.
- Referred patients have to wait outside the facility in the early hours of the morning to be transported.
- Medical Depot
- There is staff shortages at the Medical Depot, especially pharmacists. This causes challenges on stock taking and tracking expired medicines.
- The depot does not have mechanisms of tracking medication that is being delivered to facilities.
- There is no system in place to verify orders or to check every content when they receive the medicines.
- The Medical Depot is using a manual system for its records and this is a concern to the Committee as it can lead to human error.
- The Committee noticed that there were large volumes of HIV treatment on stock and was kept in a secured area.
The Committee recommends that the Free State Department of Health ensure the following:
- Prioritise the issue of infrastructure and staff shortages at Ikgomotseng Clinic.
- Address staff shortages at the Medical Depot.
- Address system bottlenecks hindering procurement and supply of medicines.
- Improve on ambulance response times.
- Address the challenges of payment and training of community health workers. This will ensure that they render effective services.
- That the community is made aware of the MomConnect and registration of expectant mother.
- Urgently address the broader administrative failures in the Lejweleputswa District.
Report to be considered
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