ATC170113: Report of the Portfolio Committee on Health on oversight visit to the North West Province from 14 - 16 September 2016, dated 13 September 2017
The Portfolio Committee on Health having undertaken an oversight visit to the North West Province from 14 - 16 September 2016, reports 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 North West Province from 14 to 16 September 2016. The purpose of the visit was to assess progress and challenges in Dr Kenneth Kaunda District as 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 health care 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 DZ Senokoanyane (ANC)
- Dr HC Volmink (DA)
The following Parliamentary Officials accompanied the delegation:
- Ms Vuyokazi Majalamba (Committee Secretary)
- Ms Lindokuhle Ngomane (Content Advisor)
- Mr Zubair Rahim (Committee Researcher)
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)
- Site Visited
The Committee visited the following facilities:
- Delekile Khoza Clinic;
- Botshabelo Community Health Centre (CHC);
- Khuma Clinic;
- Nic Bodenstein Hospital;
- Kgakala Clinic; and
- Majara Sephapho Clinic.
3.1. Delekile Khoza Clinic
On 14 September 2016, the Committee conducted its oversight visit at Delekile Khoza Clinic and met the following delegation:
- Ms DS Ntutle (Facility Manager)
- Ms MF Kobeli (Quality Coordinator)
- Mr HN Matshoba (Deputy Manager: Nursing)
- Dr Uma Nagpal (Provincial DDG: National Health Insurance)
- Mr Andre Smith (District Manager)
The Committee was given a brief overview of the facility profile. Services provided includes HIV/AIDS related care, sexually transmitted infections (STIs), tuberculosis (TB), immunization, mother and child care, men and women’s health and chronic and curative care.
The facility operates from Monday to Friday. There are four professional nurses, two assistant nurses, one cleaner, an administration clerk and a data capturer. The facility does not have staff nurses and groundsman.
The Committee went on a walkabout and noted that the facility is very small. Patients complained that they wait long before they are attended to. There was a general lack of space such that the storeroom is also used as a laundry room.
The facility reported to use the stock visibility system to ensure that there are no drug stockouts. The Clinic Committee is functional, meets on a monthly basis and assists in maintaining the facility grounds. The facility has two health care waste storage areas, one for storing waste and the other for new waste containers.
On school health, there are four teams which consists of a staff nurse and only one environmental health practitioner for the ward. There are no health promoters and assistant nurses. On the HPV campaign, 92% of learners were reached. Challenges relates to the lack of vehicles and signing of consent forms by parents.
The facility noted that the waiting time for an ambulance is long as it takes about four hours or longer. This results in staff using own cars to transport patients. The facility has implemented the Central Chronic Medicine Distribution and Dispensing (CCMDD) programme.
In the park home/consulting rooms, the Committee noted the lack of blood pressure (BP) machines, as well as the storage for non-functional equipment and wheelchairs. It also noted computer equipment still in boxes. The clinic reported that water supply was a challenge.
3.2. Khuma Clinic
The Committee went on a walkabout and noted that the facility grounds were clean. The services for cleaning the grounds are outsourced.
The Committee noted a dental room which is not functional due to lack of funds to run dental services. The Committee also noticed that the medicine storeroom, was not locked, some of the items were not labelled and lighting was poor. At the dispensary, the Committee noted that the dispensary does not have a pharmacist or pharmacist assistant and there was a lack of space. The facility does not have a back-up generator or a water tank.
The facility renders a full PHC package including CCMDD. The staff complement includes; three professional nurses, two enrolled nurses, two cleaners, an administration clerk and a data capturer. Laundry is done at the provincial laundry in Klerksdorp. The facility had NHI sessional doctors, however at the time of the visit their contracts had expired.
The facility records a high number of HIV and TB cases, with high defaulter rates. The Clinic Committee had no chairperson at the time of the visit, however, members of the Clinic Committee assist the facility with queue marshalling and food gardens. There are 14 community health workers, each covering approximately 220 households. There are no outreach team leaders due to contracts expiring.
Staff shortages, long waiting times, lack of medical equipment (i.e. blood pressure machines), not having in-facility laundry and lack of budget for repairs and maintenance were highlighted as challenges confronting the facility.
3.3. Botshabelo Community Health Centre
The Committee went on a walkabout in the old CHC building and the recently built maternity unit. The facility serves a population of approximately 25 000 people, offers 24 hour services and attends to approximately 4500 clients per month. The staff complement includes, 20 professional nurses, four auxiliary nurses, one enrolled nurse three clerks, a data capturer, groundsman and four cleaners. There are 13 community health workers for outreach services with no team leaders and 9 DOTS (Direct Observed Treatment, Short course) supporters. The old CHC building has three (3) consulting rooms, a staff changing room, sluice room and patient changing room. Whilst it has a pharmacy it has no pharmacist. It has an operational manager, who is acting as the facility manager.
The new maternity unit came about as an agreement between AngloGold Ashanti, the North West Department of Health and the Matlosana Local Municipality. The maternity unit offers the following services: antenatal and postnatal rooms, sonar, dispensary, nursery and sterilisation room and staff room with a separate lounge. The maternity unit offers mothers and babies privacy, dignity and confidentiality required in a modern mother and child health care unit.
The facility reported the need for improved water supply; additional cleaners and data capturers; disposal of redundant and old equipment; refurbishment and maintenance of the old CHC building; a telephone line in the new maternity unit; improved safety measures due to gangsterism in the area; and a walkway which will connect the two buildings.
3.4. Nic Bodenstein Hospital
The Committee met with the following officials at the hospital:
- Dr I Wana (Acting Chief Executive Officer)
- Dr Israel Raphala Mahume (Acting Clinical Manager)
- Mr Thabiso Kxasi (Auxiliary Support Services)
- Mr Mpho Moses Makulako (Acting Cleaning Services)
- Ms Angelina Segami (Operational Manager: Quality Assurance)
- Mr Ramotala Mabe (Mother and Child and Women’s Health Coordinator)
- Mr NL Maruping (Station Manager)
- Mr Tshepaone Mosselly Tong (Labour Relations Officer: Sub-District)
- Mr Tebogo Ben Kenalemang (CPO)
- Mr SJ Marake (CPO)
- Mrs Mandiswa Getrude Sebolai (Operational Manager)
- Ms KM Sebitso (Operational Manager)
- Mrs Wilma Holtzhausen (Professional Nurse)
- Mr William Sanyane (Professional Nurse)
- Mrs Nokwanda Mable Bobe (Professional Nurse)
- Mr MS Sehloho (Focal Person: WBOT)
- Mr TP Sewo (Project Officer Care and Support)
- Miss T Tshenolo (Professional Nurse)
- Ms ME Makwetla (Nursing Service Manager)
- Mrs ME Makgata
Dr Wana, the Acting CEO provided the Committee with a brief overview of the hospital. Nic Bodenstein Hospital is a level one district hospital in Maquassi Hills. It has six feeder clinics and two CHCs. The hospital has 88 usable beds. Services provided at the facility are clinical and support services. Clinical services include, paediatric ward, maternity ward, theatre, out-patient department and a 24-hour service casualty. Support services include, radiology, dietetics, social work and pharmacy.
The staff complement includes; six doctors, three clinical associates, two radiographers, 32 professional nurses, two community nurses, 16 enrolled nurses, 28 enrolled nursing assistants, three advanced midwives, three porters, two kitchen staff and five groundsmen. There are no theatre trained nurses. Catering and security services are outsourced. Laundry is done at the provincial laundry in Klerksdorp.
The facility has a functional Hospital Board that meets bi-monthly. Emergency services are also provided at the centre. There are three ambulances and one obstetric ambulance.
The Committee noticed that the wards floors were clean, however, wall paint was peeling and there were beds with broken legs. In the maternity ward, the Committee observed that only one toilet worked due to plumbing challenges.
The Committee noted many pipe leaks in many of the wards. The hospital explained that there was no plumber onsite to repair the pipe leaks, they have since lodged a request with the Department of Public Works. The Committee observed the shortage of pharmacy staff and lack of space in the pharmacy. The Committee also noted the lack of trained staff in theatre.
The Committee observed that the kitchen is well managed, however, was concerned that the catering was outsourced whilst the staff and equipment belongs to the hospital. Also, the catering staff should wear proper safety equipment such as boots etc. In the boiler room, the Committee noticed a pipe leaking boiling hot water near electrical wires.
The main challenges confronting the facility relates to budget constraints as the hospital’s budget would be depleted by the end of September, shortage of staff (29% vacancy rate) due to the moratorium on the filling of vacancies, shortage of linen, and drug stockouts at times.
- Kgakala Clinic
The Committee went on a walkabout and noted that the facility is very small. There was no running water on the day of the visit. Water supply is from a small water tank. The facility manager reported that they have backlogs on HIV test and treat due to staff shortages. The facility manager mentioned that the area is faced with a high burden of child malnutrition, TB and teenage pregnancy.
There is a ward-based outreach team attached to the clinic. It consists of seven community health workers and two team leaders. The clinic attends to approximately 80 patients per day. The Clinic Committee is functional. There are two mobile teams and visits bi-weekly. The facility has an NHI sessional doctor who visits the facility thrice a week.
Challenges are staff shortages, lack of space and shortage of running water. In terms of infrastructure needs, the facility needs to be expanded as there is no space to accommodate a back-up generator and a bigger water tank.
- Majara Sephapho Clinic
The Committee went on a walkabout and noted that the clinic is very small. There is no running water, water is sourced from a water tank. There is no back-up generator. Due to the lack of space, the toilet is attached to the data capturer’s office and the dressing room is also used as an observation room.
The clinic attends to approximately 2000 patients per month. There is a ward-based outreach team attached to the clinic that consists of 18 CHWs, covering 10 households each. There are no outreach team leaders. The Clinic Committee is functional. Two Dietitians serve eight facilities each in an area where malnutrition is high.
The clinic experiences very long waiting times for ambulance services. Other challenges highlighted include, lack of space, running water supply, high patient headcount and staff shortages.
- Meeting with the Member of the Executive Committee (MEC)
Having concluded its oversight in North West, the Committee had a feedback meeting with the MEC and raised major issues that are in the report.
- Overall findings and observations
The Committee made the following findings and observations:
- Human resources
The provincial department suffers from staff shortages with critical posts not being filled due to a moratorium on the filling of vacancies. Funded posts are not filled. For instance, in Nic Bodestein Hospital, the CEO position has been vacant for over 12 months and the Acting CEO has not been offered an acting allowance.
- Financial management
The Committee noted with concern the weak financial position of the provincial department. The department is accumulating accruals which negatively impact on the filling of critical posts and the payment of suppliers. The budget of the provincial department is depleted well before the end of the financial year. This leads to payment of invoices in the following financial year, much later than the prescribed 30-day payment period.
In the clinics visited, the Committee noted the shortage of space and the overcrowding of admission areas. Kgakala Clinic is one of the worst affected and has no land for expansion.
Maintenance and repairs budget seems to be a challenge. Nic Bodestein Hospital needs to be refurbished and maintained, and the pharmacy needs to be expanded. However, maintenance work cannot be done due to a lack of financial delegations. There are numerous water leakages around the facility which needs to be repaired by the Department of Public Works.
Clinics raised concerns relating to medical equipment, the lack of and the poor quality of the procured equipment under the NHI Grant.
The two sub-districts (Maquassi Hills and Matlosana) are experiencing poor water supply. Kgakala Clinic, Khuma Clinic and Botshabelo CHC were found to be the most affected facilities. Kgakala Clinic has a small water tank and no water supply from the municipality.
A number of services are outsourced, including catering, security services, laboratory and medical waste. In Nic Bodenstein Hospital, the Committee noted with concern that catering is outsourced whilst the service provider utilizes hospital staff and equipment. The facilities reported shortages of linen, whereby patients goes without linen and have to use own linen. Laundry services are centralised at the provincial laundry in Klerksdorp.
- 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 regular basis. In some instances the Clinic Committee assists in the up keep of the clinic grounds, queue marshalling, campaigns and food gardens.
- PHC re-engineering
Ward-based outreach teams and community health workers, contracts for team leaders expired and have not being renewed. All the teams operate without team leaders.
On school health programme, one of the main challenges found is the shortage of school health mobile vehicles.
- Emergency Medical Services
Ambulance response time is slow, taking on average four hours or longer. In many cases this leads to staff having to use their own cars to transport patients.
The province reported to having contracted private ambulances (Buthelezi Ambulance Service) to supplement the provision of ambulance services; the Committee was concerned about the costs involved.
- Stock availability monitoring
Most facilities have implemented the stock availability system particularly for vaccines, TB drugs and ART. CCMDD is being implemented in most of the visited clinics.
The North West Provincial Department of Health should:
- Ensure that priority health personnel vacancies are filled, as well as the recruitment and retention of health professionals.
- Urgently address the issue of acting positions over extended periods of time by timeously filling vacated positions.
- Ensure that personnel in acting positions are compensated with acting allowance where required.
- Develop a turnaround strategy that would focus on financial policies to address accruals that further depletes the budget of the department.
- 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 infrastructure challenges and general maintenance are urgently attended to.
- Pay attention to the procurement of medical equipment in order to ensure that good quality and quantity of equipment are procured.
- Ensure the procurement of good quality linen.
- Ensure that clinics are provided with water and electricity back-up systems.
- Ensure that key services are insourced in health facilities.
- Ensure the strengthening of primary health care programmes particular the ward-based outreach teams and school health programme.
- Ensure access to emergency care by improving emergency medical services response time in order to improve patient outcomes.
Report to be considered.
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