ATC170913: Report of the Portfolio Committee on Health on oversight visit to Free State Province from the 20 – 21 September 2016, dated 13 September 2017
Report of the Portfolio Committee on Health on oversight visit to Free State Province from the 20 – 21 September 2016, dated 13 September 2017.
The Portfolio Committee on Health having undertaken an oversight visit to the Free State Province from the 20 - 21 September 2016, report as follows:
One of the functions of the Portfolio Committee on Health is to conduct oversight over the Department of Health and its entities. The Committee conducted its oversight visit in the Free State Province from the 20 to 21 September 2016. The purpose of the visit was to assess progress and challenges in Thabo Mofutsanyane District is one of the National Health Insurance (NHI) pilot districts.
A decision was taken in 2010 to pilot the NHI in ten pilot districts. The pilot districts are a mixture of districts based on their economic status, diseases burden and the performance of health districts. The NHI piloting is based on investing in infrastructure development and maintenance; contracting of general practitioners (GPs) to work in primary health care facilities; re-engineering of primary healthcare system (which will be delivered through three streams namely, school health programme; municipal ward-based outreach teams; and ensuring the quality of health services.
The delegation comprised of the following Members of Parliament:
- Ms ML Dunjwa (ANC and the Chairperson of the Committee)
- Mr AF Mahlalela (ANC)
- Dr P Maesela (ANC)
- Ms CN Ncube Ndaba (ANC)
- Ms L James (DA)
The following Parliamentary Officials accompanied the delegation:
- Ms Vuyokazi Majalamba (Committee Secretary)
- Ms Lindokuhle Ngomane (Content Advisor)
- Mr Moses Mncwabe (Committee Researcher)
- Ms. Yoliswa Landu (Principal Communications Officer)
- Ms. Nombali Magubane (Committee Assistant)
The following officials from the National Department of Health accompanied the delegation
- Mr Johannes Kgatla (Acting Chief of Staff in the Office of the Minister)
- Mr Moremi Nkosi (Technical Advisor: National Health Insurance Policy)
- Mr Christie Engelbrecht (Acting Cluster Manager)
- Mr David van der Welt
- Site Visited
The Committee visited the following health facilities:
- Mofumahadi Manapo Mopeli Regional Hospital;
- Mphatlalatsane Clinic;
- Ma-haig Clinic; and
- Dihlabeng Hospital.
3.1. Mofumahadi Manapo Mopeli Regional Hospital
On 20 September 2016, the Committee conducted its oversight visit at Mofumahadi Manapo Mopeli Regional Hospital, and it met the following delegation at the hospital:
- Ms DS Ntutle (Chief Executive Officer (CEO))
- Ms MF Kobeli (Quality Coordinator)
- Mr HN Matshoba (Deputy Manager: Nursing)
- Dr AM Letsele (Clinical Manager)
- Ms Iris Mathe (Operational Manager)
- Ms DL Molefe (Area Manager)
- Ms NR Moloi (Area Manager)
- Mr TD Mahlobo (Area Manager)
- Ms NE Mopeli-Makwanyane (Area Manager)
- Mr MD Mafohla (Maintenance)
- Ms ME Mofokeng (Operational Manager)
- Dr Grace London (Chief Director: District Health Services)
- Mrs Masebina Ramokoho (Deputy Director: Primary Health Care)
- Mrs Masebina Ramokotlo (Deputy Director: Primary Health Care)
- Ms RPG Maarohanyane (District Director)
- Mr MP Motaung (Acting Human Resources Manager)
- Mr KJ Mocwagae
- Mr AL Kilane
- Ms Lotti Rutler (Treatment Action Campaign (TAC) National Office)
- Mr Oupanyana Mahotsiau (Free State TAC Chairperson)
- Ms Nomatter Ndebele (Section 27 Journalist)
The Committee went on a walkabout and observed the following:
3.1.1. Resuscitation room
The Committee observed that the ward was clean, however noticed the space challenges as there was renal stock lying in the passageway.
3.1.2. Labour Ward
The Committee was informed that hospital is experiencing a shortage of linen; at times patients have to bring own linen. The quality of linen is also a challenge.
The Committee noted that the kitchen was not well kept. Catering is outsourced, however, the staff belongs to the hospital and shared with Elizabeth Ross Hospital. Meat was not properly stored. The Committee observed that the kitchen was dirty and had a bad smell. The challenges for the kitchen staff relates to changes in service providers that comes with own conditions of service; salary cuts; lack of proper protective clothing and uniform; and the lack of pension and other benefits. It was reported that some of the staff members have been on temporary basis since 1987. Given that they have been employed as temporary, they reported being in the same position with stagnant and sometimes fluctuating salaries.
The kitchen equipment has long collapsed. The Committee noted the peeling ceiling. Some of the kitchen supplies such as spices and cleaning detergents have expired. The light bulbs were not replaced in some sections of the kitchen compromising the lighting. The kitchen itself showed a state of disrepair or poor maintenance system.
The pharmacy is small in size. The pharmacist informed the Committee that medicines are always available, at 80-90%. The pharmacist further indicated that it takes three to five minutes to dispense and approximately two hours when there is a long queue.
The hospital does not have an in-house laundry. Laundry is done in Qwaqwa laundry. The Committee was informed that the laundry staff is insufficient have not had uniform for more than four years, however in the process of being procured.
- Transport and Mechanic
The Committee was informed that the hospital has ten sedan vehicles which transport Cuban doctors. It was also informed that there is one mortuary van, one tractor and one forklift. The state of fitness to perform their respective functions is not ideal as there is one mechanic who is responsible for keeping all vehicles roadworthy. The Committee also learnt that the one mechanic has no proper equipment and uniform to enable him to do his job effectively and safely.
- Male Toilets
As the Committee moved around the hospital, it noticed some male toilets were very dirty and some with no light bulbs. The reason for this, was that there was inadequate staff complement to ensure cleanliness and maintenance of bathrooms/ toilets.
The boiler has not been working for almost five days, however, there had been no response from the contractor. Some of the problems that were explained to the Committee is that the contractor used uninsulated wires causing some of the defects on the boiler. The officials responsible for manning the boiler reported to the Committee of being understaffed.
There are two generators at the facility that are not working. The Committee noticed diesel leaks. The generators were last tested on 31 August 2016.
The Committee noted that it was clean and well kept. It also noted that the records of the deceased were entered accordingly on the main mortuary register. The challenge mentioned was shortage of staff. The Committee was however concerned about calendars from different funeral parlours.
- Infrastructure observations
The Committee met with an employee responsible for maintenance, who informed the Committee that the maintenance unit had nine officials, however, eight have since resigned. This official is left to do the maintenance for the whole hospital including underground work. He further informed the Committee that a service provider that was contracted for plumbing left the job unfinished. Due to the lack of maintenance staff, an administration clerk was found to be working as a cleaner and painter. Air filters have not been changed in a while and this was noted as an infection control hazard.
Following the Committee’s visit to the different units of the hospital, a civil society organisation was protesting outside the hospital about the challenges of the hospital.
The Committee also observed the lack of security personnel at the hospital entrance, as security officers were on strike on the day of the visit.
- Mphatlalatsane Clinic
The Committee had a walkabout at the clinic and noted that the facility was small and overcrowded.
Medicines at the dispensary were labelled accordingly. The facility manager informed the Committee that they order stock every month. She further indicated that they also have a communication platform with other facilities which facilitates sharing of stock when needed.
The facility has implemented the Centralised Chronic Medication Dispensing and Distribution (CCMDD). This programme allows for patients to collect their pre-packed medicines without having to wait in long queues.
- Ma-haig Clinic
The Committee had a walkabout and noted that the clinic is well kept but very small. Patients complained that they wait long before their attended to. The facility explained that the long waiting times are attributed to the new patient registration system. The Committee was also informed that Ma-haig was the least performing facility in the district.
- District Office
Having concluded the walkabout at the clinic, the Committee had a meeting at the district office as follows:
The District Manager, Mr Maarohanye made the presentation to the Committee and gave an overview of the district. Thabo Mofutsanyane district has an estimated population of 834 290 according to StatsSA. There are 73 clinics, nine district hospitals and two regional hospitals in Thabo Mofutsanyane. The district has six sub-districts namely: Maluti A Phofung, Dihlabeng, Nketoana, Phumelela, Setsoso and Mantsopa.
Ma-haig and Mphatlalatsane Clinics are both in Maluti A Phofung in Qwaqwa with catchment populations of 6936 and 10 532, respectively. Both clinics are operating eight hours per day and five days per week, excluding weekends and holidays.
It was further reported that there are two district hospitals within the radius of Ma-haig and Mphatlalatsane Clinics, Elizabeth Ross District Hospital and Mofumahadi Manapo Mopeli Regional Hospital.
On National Health Insurance implementation, the district highlighted that Mphatlalatsane Clinic has enrolled 211 patients on CCMDD and utilising six private pick up points namely; Clicks Pharmacy, Dr Mosia, Leseding Pharmacy, Maluti Pharmacy and Naledi Pharmacy. Ma-haig Clinic has enrolled 624 patients on CCMDD.
Both facilities are to be provided with internet connectivity in 2016/17 financial year. Rx Solutions has been implemented and the clinics manages stock using Rx Solutions. Both facilities are installed with the Health Patient Registration System.
The following were reported as infrastructure challenges for Ma-haig and Mphatlalatsane Clinics:
- Ma-haig Clinic is having two main brick buildings and an extension of a modular structure.
- There were cracks on the walls, ceiling caving in and roof leaks in Ma-haig Clinic; a new contractor is due to start with major building maintenance and during the maintenance the modular structure will be used.
- Mphatlalatsane is having a contractor on-site and busy with renovations.
Medicines and consumables availability for September 2016 for both facilities was at 100%. On contracting of general practitioners (GPs), 26 GPs have been contracted and visiting clinics on an average of one visit per week.
Challenges included the scourge of substance abuse around the district whereby ARVs are being stolen at the pharmacy as well as rising cases of acute malnutrition.
- Dihlabeng Regional Hospital
The Committee met with the following delegation:
- Dr B Malakoane (Member of the Executive Committee (MEC))
- Dr D Motau (Head of Department (HOD))
- Mr Tsietsi Makume (Chief Executive Officer (CEO))
- Dr WJ Selfridge (Clinical Manager)
- Mrs ME Royi (Deputy Director: Nursing)
- Ms S Mpanza (Head of Administration)
- Mr SC Polelo (Deputy Director General)
- Mr GM Radile (Chief Director)
- Mr M Fikizolo (Deputy Director General)
- Mr N Baartman (Engineer)
- Mr NT Mohale (Clinical Programme Coordinator)
- Mr HE Nagel (Quality Assurance Coordinator)
- Mr NL Makamde (Infection Prevention and Control Coordinator)
- Mr RPG Maarohanye (District Director)
- Mr L Litheko Neburghs (Internal Communications)
- Mr Tseliso Macheli (Communication Officer)
- Mr Prince Litabe (Communications Officer)
- Ms Thabiso Gamede (Lesedi FM Journalist)
- Ms Maletsatsi Wetsen (Qwaqwa Radio Journalist)
- Ms Bontle Motsoeneng (Health e-news Journalist)
The Committee went on a walkabout and noted the following:
The Committee noted that the generator was functioning well, safely stored, well-kept and it is tested every Friday.
The pharmacy was fully stocked and medicines are properly labelled.
The Committee observed that the mortuary was clean and organized.
Having concluded the walkabout, Mr Makume (Hospital CEO) presented the hospital profile. Dihlabeng Regional Hospital serves a catchment population of 301 625. Services rendered at the hospital are the following: trauma, medical services, surgery, anaesthesiology, obstetrics and gynaecology, neonatal high care, paediatrics, orthopaedics, radiology, intensive care unit and high care services, oncology, ophthalmology, diabetics, arthritis, genetics, child psychiatry, haemotology, dermatology and paediatric orthopaedics.
- Meeting with the Member of the Executive Committee (MEC)
Having concluded its oversight in Free State, the Committee had a feedback meeting with the MEC and raised major issues that are in the report.
- Findings per facility
- Mofumahadi Manapo Mopeli District Hospital
- The Committee expressed concern on the management and leadership of the hospital;
- There are critical staff shortages across all staff categories;
- There are challenges with delays in the filling of vacancies as the Department is under provincial administration, with Provincial Treasury having to sign off on all appointments;
- Key services like catering and security are outsourced;
- The Committee noted with concern regarding the kitchen staff as some of them have been working at the kitchen on a temporary basis since 1987, they are not provided uniform or protective clothing; and
- There is only one employee responsible for maintenance work of the whole hospital.
- Mphatlalatsane and Ma-haig Clinics
- Both clinics have infrastructure challenges, they are both very small in size;
- There are staff shortages; and
- There is a high patient load which leads to long waiting times.
- Dihlabeng Regional Hospital
- The hospital is well managed;
- The staff at the facility is motivated and committed;
- All the units visited by the Committee were found to be clean;
- Kitchen and security services are not outsourced;
- Maintenance is done in-house;
- There is a need for infrastructure maintenance and refurbishment; and
- Linen is of good quality and supply from the laundry is consistent.
6. Overall findings and observations
The Committee made the following findings and observations:
- Human resources
The provincial department suffers from critical staff shortages across all staff categories. This in turn leads to long patient waiting times. The department is under administration thus experiencing a delays in the appointment of staff and delays in the procurement of services.
The Committee observed that in all the clinics visited there were doctors contracted under the NHI which is commendable.
Infrastructure maintenance and refurbishment is required in both hospitals (Mofumahadi Manapo Mopeli and Dihlabeng).
There was a general lack of space at the clinics visited with Mphatlalatsane Clinic being the most affected. The clinics have been experiencing poor water supply for over a period of nine months.
Lack of back-up generators: Clinics do not have backup generators in the event of electricity disruptions.
Catering and security services are insourced in Dihlabeng and outsourced in Mofumahadi Manapo Mopeli. There seems to be a parallel system.
- Governance structures
In most of the facilities visited, governance structures do exist and have a good relationship with the health facilities. Most of the Clinic Committees and Hospital Boards reported to having meetings on a monthly basis.
- PHC re-engineering
Ward-based outreach teams are fully functional. The district clinical specialist team (DSCT) is not a full complement.
- Emergency Medical Services
Ambulance response time is long, taking three hours or longer. The province has contracted private ambulances (Buthelezi Ambulance Service) to supplement the provision of ambulance services, the Committee was concerned about the costs involved.
- Mobile clinics
Mobile service provision is inconsistent; visits are done every four to six weeks.
- Drug monitoring
All the clinics visited have implemented the stock availability system and share stock with other facilities. CCMDD is being implemented.
The Committee learned that most of the key services functions are outsourced at exorbitant prices, while service rendered is also compromised.
The Free State Provincial Department of Health should:
- Ensure that priority health personnel vacancies are filled, as well as the recruitment and retention of health professionals.
- Ensure the upskilling of hospital management to improve the quality of hospital management.
- Ensure that infrastructure challenges and general maintenance are attended to, urgent attention is required in Mofumahadi Manapo Mopeli Hospital.
- Address the shortage of space in worst affected clinics by constructing a new structure or providing a park home as a temporary measure.
- Ensure that clinics are provided with water and electricity back-up systems.
- Ensure that key services are insourced in health facilities.
- Ensure that clinics and hospitals have security officers.
- Ensure that clinic committees and hospital Boards are fully functional.
- Ensure the strengthening of primary health care programmes particular the District Specialist Clinic Teams.
- Ensure access to emergency care by improving emergency medical services response time in order to improve patient outcomes.
- Ensure the provision of mobile services to farms and rural areas.
Report to be considered.
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