ATC181031: Report of the Portfolio Committee on Health on an oversight visit to KwaZulu-Natal Province from 14 to 17 August 2018, dated 31 October 2018


Report of the Portfolio Committee on Health on an oversight visit to KwaZulu-Natal Province from 14 to 17 August 2018, dated 31 October 2018


The Portfolio Committee on Health (the Committee) undertook an oversight visit to KwaZulu-Natal Province in the uMgungundlovu District, which is a National Health Insurance (NHI) Pilot site, and eThekwini Metropolitan on 14 to 17 August 2018. The Committee reports as follows:  


  1. Purpose of the visit


One of the roles of parliamentary committees is to ensure that government is accountable at all times, by conducting oversight particularly on the ground to ensure that service delivery takes place as per legislation. 


A decision was taken in 2010 to pilot the NHI in different provinces. The pilot districts are a mixture of districts selected on their economic status, diseases burden and the performance of the health districts.  The NHI piloting is based on investing in infrastructure development and maintenance, contracting of general practitioners (GPs) to work in public clinics, re-engineering of primary healthcare system (delivered through the municipal ward-based outreach teams, integrated school health programme, and district clinical specialists teams).


  1. Delegation


The delegation comprised of the following Members of Parliament:


  1. Mr AF Mahlalela (ANC) – Leader of Delegation
  2. Dr P Maesela (ANC)
  3. Ms CN Ncube Ndaba (ANC)
  4. Mr D Maphanga (ANC)
  5. Mr TM Nkonzo (ANC)
  6. Ms P Kopane (DA)
  7. Ms W Wilson (DA)
  8. Mr SM Jafta (AIC)


Parliamentary Officials that accompanied the delegation:


  1. Ms Vuyokazi Majalamba (Committee Secretary)
  2. Ms Nombali Magubane (Committee Assistant)
  3. Ms Lindokuhle Ngomane (Content Advisor)
  4. Mr Moses Mncwabe (Committee Researcher)
  5. Mr Zubair Rahim (Committee Researcher)
  6. Ms Yolisa Landu (Communication Officer)


Officials from the National Department of Health:


  1. Dr Anban Pillay: Deputy Director General  
  2. Ms Shareen Pardesi: Chief Director


  1. Sites Visited


The Committee visited the following facilities:


  1. Msunduzi Local Municipality: Imbalenhle Community Health Centre; Mpumuza Clinic; Edendale Regional Hospital; Fort-Napier Psychiatric Hospital; and Grey’s Tertiary Hospital.
  2. uMshwathi Local Municipality: Cramond Clinic; Gcumisa Clinic; Appelsbosch District Hospital.
  3. uMngeni Local Municipality: Mpophomeni Clinic and Umngeni Psychiatric Hospital.
  4. eThekwini Metropolitan Municipality: Umlazi V Clinic; Cato Manor Community Health Centre; Prince Cyril Zulu Communicable Diseases Centre; and Addington Regional Hospital.  



3.1.Mpumuza Clinic


On 14 August 2018, the Committee visited Mpumuza Clinic and held discussion with the following health officials at the facility:

Ms Kholeka Makhathini: Advanced Midwife

Mr Siyabulela Mgwatyu: District Finance Manager

Ms Sohana Roopan: Assistant Manager, Nursing, Planning, Monitoring and Evaluation

Ms Bulelwa Biyela: District Pharmacy Manager

Ms Subeda Kundethe: Acting Deputy Nursing Manager

Miss Thobile Hadebe: Senior Communications Practitioner

Mr Nkululeko Mkhize: Assistant Director – Finance

Mrs Nontsikelelo Ralgane: CDC Manager

Mr MR Creen: Deputy Director – Planning, Monitoring and Evaluation

Mr J Muncu: Chief Works Inspection

Mr Sibusiso T Mhlongo: Chief Construction Project Manager

Mrs MT Zulu: Deputy Director – NHI


Mpumuza is located in Msunduzi local municipality in Ward 2.  It is a semi-rural area, situated sixteen kilometres away from Pietermaritzburg.  The clinic is linked to Edendale Hospital as a referral institution, which is approximately 12 km away.  It is a category B (primary health care facility structure) and operates 12 hours a day, five days a week. It has a catchment population of 38 504 and attends about 6000 –7000 clients per month.  It serves population from Wards 1, 2, 3, 4 and beyond.  The facility works with the local leadership such as Inkosi, Izinduna and Ward Councillors of the above-mentioned wards.


The clinic offers the following services: Acute services (minor ailments); Chronic services; Maternal, Child, Women’s Health & Nutrition (MCWH & N); HIV and Aids, sexually transmitted infections and Tuberculosis (HAST); General Practitioner coverage (GP Contract); Community Care Givers (CCGs); WBOTS (Ward based outreached teams); and Central Chronic Medicine Distribution and Dispensation (CCMDD).



The facility management reported the following achievements in relation to NHI:

  • There is a contracted General Practitioner available eight hours a day, five days a week.
  • A pharmacy assistant has been appointed.
  • The stock visibility system (SVS) and treatment solution (through the referral hospital) has been implemented.
  • The electronic Health Patient Record System (HPRS) has been implemented.
  • Signage and medical equipment has been procured.
  • NHI stakeholder feedback workshops combined with community dialogues were conducted to address health challenges.
  • Network connectivity has been rolled out to the clinic – access to emails, intranet and internet.
  • Various IT equipment (computers, printers and copiers) were procured for the clinic.
  • Infrastructure upgrades such as paving, roof and ceiling board repairs, installation of handwashing facilities.


The facility reported the following as the successes:

  • The facility has achieved Gold Ideal Clinic status.
  • Renovations have been conducted.
  • There is access to internet and web-email.
  • The facility is using the electronic patient record system.


The following challenges were highlighted:

  • Shortage of administration personnel; there is only one Community Service Officer working for eight hours a day whilst the clinic operates 12 hours a day.
  • There are infrastructure challenges.  A waiting area is not covered and patients wait outside in all weather conditions.
  • There is insufficient space for filing and pharmacy.





The Committee observed the following:

  • The facility is very small (yet it serves four wards) and there are no plans to build a new clinic nor extend the existing structure.
  • There is a structure provided in 2016 by the National Department of Health (NDoH) under NHI that does not have a sheltered waiting area.
  • Security is outsourced to Ilanga Security Company.
  • There is a shortage of data capturers.
  • The Committee observed that the clinic is experiencing a shortage of medicines. Most of the cupboards were found empty. 
  • The filing system needs to be reorganised - it is currently in another building which present long waiting times for the retrieval of files.
  • The Committee observed with concern that the medical equipment (BP machine, suction and defibrillator) have not been calibrated since 2014/15.


The Committee interacted with the patients who raised their concerns as follows:

  • Patients complained of long waiting time due to staff shortages.
  • Ambulance services are not available after 17:00.
  • Some complaints were related to shortage of medicines; ablution facilities constantly not functioning; and insufficient security personnel.


  1. Edendale Regional Hospital


On 14 August 2018, the Committee proceeded to Edendale Regional Hospital. The Committee met with the following officials:

Mrs NT Nxaba: Chief Executive Officer

Dr EK Mthembu: Senior Manager – Medical Services

Mrs S Masemola: Deputy Manager Nursing

Mr D Thangalan: Deputy Director – Finance

Mr NC Ntuli: Deputy Director – HRM

Mr MG Naidoo: Deputy Director – Systems

Mrs NC Majola: Principal – Edendale Nursing College

Ms Kholeka Makhathini: Advanced Midwife

Mrs VT Zulu: Chief Human Resource Officer

Ms Thandi Margaret Dlamini: Assistant Manager – Nursing

Mr Siyabulela Mgwatyu: District Finance Manager

Ms Sohana Roopan: Assistant Manager, Nursing, Planning, Monitoring and Evaluation

Ms Bulelwa Biyela: District Pharmacy Manager

Ms Subeda Kundethe: Acting Deputy Nursing Manager

Miss Thobile Hadebe: Senior Communications Practitioner

Mr Nkululeko Mkhize: Assistant Director – Finance

Mrs Nontsikelelo Ralgane: CDC Manager

Mr MR Creen: Deputy Director – Planning, Monitoring and Evaluation

Mr J Muncu: Chief Works Inspection

Mr Sibusiso T Mhlongo: Chief Construction Project Manager

Mrs MT Zulu: Deputy Director – NHI

Mrs Phakama Sigcawu: Personal Assistant to the CEO


Mrs Nxaba, Chief Executive Officer, briefed the Committee and noted that Edendale Hospital is a regional hospital situated in Pietermaritzburg.  It is located in uMgungundlovu District which is the second most populated district in KwaZulu-Natal Province with a total population of approximately 1.4 million. The budget of the hospital is just over one million.  It has 900 usable beds.  It is the fourth biggest hospital in the country in terms of bed numbers.  It supports 17 clinics, three mobile clinics and is a referral hospital for Harry Gwala District.  It offers a full package of regional and some tertiary services.  It is a teaching hospital with full academic status.


The following services are rendered at the facility: Primary health care, Internal Medicine, Surgery, Paediatrics, Orthopaedics, Obstetrics and Gynaecology, Ophthalmology, ENT, Urology, Dermatology, Psychiatry, Anaesthetics, Radiology, Critical Care, Emergency Department, HCT, MMC and Family Planning, ART rollout and TB Management, Termination of Pregnancy facility, PMTCT Programme, Thuthuzela Care Centre, Pharmacy, Social Work, Speech & Audiology, Occupational Health, Clinical Psychology, Dietetics, Dental, Laboratory Services (NHLS), Physiotherapy, Blood Bank and Youth Health Services.

The following achievements were highlighted:

  • There is a functional human milk bank benchmarked by King Dinizulu Hospital and Clairwood Hospital.
  • Maternal care indicators have improved due to outreach teams visiting facilities not performing well with maternal care.
  • There is vast improvement across maternal, infant and child health, which formed a large portion of the concerted effort.
  • All diagnosed HIV positive patients are on ART.
  • TB management is successfully implemented with the support of Gene-Xpert.
  • Chronic Diseases management is well coordinated and implemented.
  • Successful management of communicable diseases.
  • There are 8000 CCMDD enrolments and a considerable number has been successfully decanted to decongest the hospital.
  • Viral load analysers installed.
  • Turnaround time for viral load testing has significantly reduced (although challenges still exist).


Challenges were reported as follows:

  • There is shortage of staff with a high turnover of doctors.
  • There is insufficient budget allocation.
  • There are lengthy SCM processes relating to medical equipment.
  • There is a high number of trauma incidents. 
  • There is an increase in chronic patients which results into increased waiting times.
  • There is drainage problem in the mortuary, which needs to be addressed.
  • There is a shortage of suitable working equipment for officials at the workshop.


Committee Observations:



Maintenance of medical equipment is a challenge.


Surgical Outpatient Department (OPD)

The Committee noted that the Surgical OPD was overcrowded and clients complained that it takes two to four hours to be attended.  There are only two doctors to attend to 120 patients a day. 


Out-Patient Department (OPD)

The Committee noticed that the OPD was overcrowded. The health professionals also reported that they also accommodate patients who have been admitted but are still waiting for beds.  Those patients sleep on stretchers. There is a shortage of consulting rooms and this results in doctors attending to four different patients in one consulting room.  This severely compromises patients’ privacy and confidentiality. The Committee noted with concern the demolition of two theatres after the 2015/16 renovation of this section. Currently there is no proper theatre, and one room is used as a procedures room.


Paediatric OPD

The Committee found that there was insufficient accommodation for adults that accompany the children who attend the different clinics. The rehydration room was not functional and children were thus referred to other wards.


Gynaecology OPD

The health professionals at the gynaecologists OPD informed the Committee that the waiting times have been reduced.   However, they noted that there is insufficient space to accommodate all patients. Approximately 1150 antenatal clients are seen on average per month.



The doctor in charge of the maternity ward informed the Committee that there is inadequate space for incubators and there is a need for an additional four incubators. 




Labour Ward

The labour ward has between 600 to 650 deliveries per month, with 40 to 45% (approximately 200) being via C-section. The labour ward is a 14-bedded unit.  The unit is in need of 17 additional beds. The Committee was informed that no epidurals are offered, as there is no staff to administer it. There is also no equipment for vacuum delivery.


Female Medical Ward  

The Committee noted that psychiatric patients were mixed with female medical patients in one ward and was informed that this occurs in the male ward as well.



The kitchen service is contracted to Compass Food. There are 92 employees, of which three belong to the department. The Committee noted that the kitchen appeared clean and orderly.



The average waiting time at the dispensing pharmacy is 10 to 15 minutes and 15 to 50 minutes at OPD. There were concerns that the pharmacy closes at 16:00, leaving patients to return for their medicines the following day, however, the pharmacist explained that basic medicines are kept at the emergency cupboard and that there is an on-call pharmacist in case of emergencies. The Pharmacy Manager indicated that the recruitment of pharmacists is a challenge. Other challenges relate to contractors’ delay in supplying; and infrastructure challenges – inadequate storage space and dispensing windows; shortage of vehicles and use old vehicles to support the 16 feeder clinics and three mobiles.



Linen is sent to the central laundry in Durban. Turnaround time is between 3 and 5 days. There is a shortage of linen, the hospital needs about 1500 additional sheets. Another challenge is that procurement is centralized at provincial office, the hospital cannot procure or buy-out when required. Furthermore, procurement is centralized to one contractor who does not have the capacity to supply.


Central Sterilizing Department

The unit services the hospital and all clinics in the district. The unit is able to supply on a weekly basis. The unit operates from Monday to Sunday, excluding night shifts. Challenges relate to staff; there is a need for an additional 20 officials.



The hospital has four generators, that are all in working condition, serviced and tested. The Committee was informed of health hazards in the workshop, which the CEO committed to address.



Shortage of staff and infrastructure challenges were identified.


Filing and record keeping

The hospital files about 2000 records a day. The filing system is manual but efficient. The hospital has been waiting for network points for three years. The main challenge relates to shortage of archiving space as records are kept for 21 years.


Nurses residence

The Committee was informed of serious infrastructure challenges such as water interruptions and plumbing challenges.



Construction activities at the hospital have been stopped and there is a water leak. According to the hospital, the contractor did not pay the sub-contractor, who left the site.





CT scanner

The Committee was informed that the CT scanner has been problematic for a number of years as there was never a maintenance contract in place. An older 64-slice CT scanner will be sent to Grey’s Hospital.


  1. Fort Napier Hospital


The Committee conducted an oversight at Fort Napier Psychiatric Hospital and met with the following officials:

Ms TN Ngcobo: Acting Chief Executive Officer

Mrs V Hlophe: Systems Manager

Dr A Mbhele: Medical Manager

Dr N Raymond: Chief Psychiatrist

Mrs G Sewran: Finance Manager

Mrs NP Gcumisa: Acting HR Manager

Mrs A Judmohan: Assistant Nursing Manager

Mr Nkululeko Mkhize: Assistant Director – Finance

Mr Siyabulela Mgwatyu: District Finance Manager

Mr Sibusiso T Mhlongo: Chief Construction Project Manager

Mrs MT Zulu: Deputy Director – NHI


Ms Ngcobo, the Acting CEO, briefed the Committee and noted that the Fort Napier Psychiatric Hospital is situated in Pietermaritzburg approximately four kilometres away from the city centre in ward 26.  This is a 370-bedded hospital. It admits observation clients, state patients and involuntary Mental Health Care Users (MHCUs) referred by courts.  Most common charges of patients that are admitted are rape (45%), murder (21%), assault (16%) and robbery/other (18%).


There are 80 patients within the facility that suffer from psychotic disorders.  These include schizophrenia, delusional disorders and other psychotic disorders.  Twenty percent (20%) of patients suffer from other disorders which include mental retardation, epilepsy, brain damage and a combination of mental retardation, epilepsy and brain damage. 


Services offered by the facility include forensic observations, psychological services, psychological rehabilitation services and occupational therapy.  Occupational Therapists assess the MHCUs functioning and place them according to their level of functioning into different vocational programs called Sebenza.  The aim is to ensure that the MHCUs achieve their highest level of functioning possible for independent living.  Sebenza includes crafts, carpentry, carwash, gardens, blocks and slabs, Industrial therapy, recycling and matelec project.


The following were highlighted as achievements for the facility:

  • The facility received a silver award in the MEC’s Annual Service of Excellence Category.
  • CCTV have been installed in the forensic unit.
  • The facility publishes in the mental health journals.
  • The roll out of ARV’s process has been initiated.


The facility is faced with the following challenges:

  • The hospital has 18% vacancy rate.
  • Lack of maintenance staff to conduct day-to-day repairs. 
  • Very large and poorly maintained grounds
  • Dilapidated, vacant and old buildings
  • Over population of MHCU’s
  • The fibre optic cable is damaged
  • The laundry equipment is old and has obsolete parts
  • There are staff shortages due to the moratorium


Committee Observations:



The Committee met with the officials working at the laundry, who complained on various issues including, being short staffed and having to perform duties that are supposed to be performed by three people.  They also highlighted that they were doing laundry for five other facilities but they were not compensated as such, their salaries were lower than their counterparts who work in other laundries, and the machinery is old and constantly breaking.  



The Committee had a walkabout on the different wards.  In Ward 9A, the Committee met with the Forensic Psychiatrist who highlighted that they were short-staffed and it is difficult to compile proper reports for the court. He noted that there are only two Forensic Psychiatrists in the province.  He further noted that they have a long waiting list, seven months long.


Occupational Health

The Occupational Therapist informed the Committee that they are providing occupational therapy services to patients so that they can be rehabilitated and be integrated back into the community.  They have approximately 70 patients on the programme and they also attend to clients who are on leave of absence.


  1. Grey’s Tertiary Hospital   


Later that afternoon, the Committee met with the following officials at Grey’s Hospital:

Dr KB Bilenge: Chief Executive Officer

Mrs KT Mckenzie: Manager – Nursing Services

Mr JZ Mntungwa: Public Relations Officer


The CEO briefed the Committee and highlighted that Grey’s Hospital has 502 beds in use.  The facility provides 100% tertiary services to area two with five districts namely (Amajuba, uThukela, uMzinyathi, uMgungundlovu and Sisonke) with a total population of 3.5 million.  Most of tertiary services are being commissioned except cardiothoracic surgery and neurosurgery. 


Services offered include general surgery, surgical sub disciplines, Obstetrics and gynaecology, Paediatrics, neonatalogy, general medicine, orthopaedics, oncology and radiotherapy, occupational health, supplementary services, clinical support services, general support services, allied health disciplines and nursing services. 


The CEO also reported progress in relation to NHI as follows:

  • First assessment by the Office of Health Standards Compliance was done in July 2013 and the facility scored 82%.
  • Every year a peer review assessment is conducted.
  • The second assessment by the Office of Health Standards Compliance was on 10 February 2016 and it scored 91%.
  • The peer review which was conducted in 2017 and the facility scored 96%.
  • The facility is still awaiting final score for a peer review that was conducted in June 2018.


The CEO highlighted the following achievements for the facility:

  • The facility scored 91% on the National Core Standards inspection.
  • The new Catherization Laboratory was commissioned.
  • The facility has built a new 21 bed Intensive Care Unit to accommodate 35 beds.
  • The facility was awarded a silver award at the MEC Annual Service Awards in 2014 and 2015.
  • The facility was ranked number three in the MEC’s Annual Service Excellence Awards in 2017.
  • The facility was ranked number one for best performing hospital in National Core Standards.
  • A 13-bedded paediatric haematology oncology unit in ward A1 for paediatric patients with cancer and blood disorders was opened.


The CEO highlighted the following challenges:

  • Staff shortages.
  • There is no clear referral system.
  • There is inadequate budget allocation.


Committee observations:


Oncology Unit

The oncology unit attends to approximately 30 chemotherapy patients a day.  There is one radiation machine.  The radiographer indicated that the radiation machine is working but it is old and outdated. Approximately 50 to 55 patients use the radiation machine per day. Approximately 85 in-patients and 50 out-patients (total approximately 130 patients) receive treatment per day. There is one CT Scanner which is used for diagnosis and planning of treatment. The Simulator machine has not been working for the past eight months. They are awaiting spare parts from the old machine at Addington Hospital. The Planning and Computer room was upgraded, but more licences are needed to increase the number of patients served. The licences cost R1 million each. The current Linear Accelerator is 12 years old, and the province is in the process of procuring a new machine for the hospital at a cost of approximately R150 million.



The emergency unit attends to referrals and walk-ins.  There are porters at the unit who are responsible for moving patients to different wards.



Linen is sent to Cato Manor. The turnaround time is seven days, which is not ideal as it leads to a shortage of linen, taking into account that on a daily basis the hospital requires 3500 pieces of linen. The challenges relate to the quantities sent and not returned and at times receiving old and torn linen when new linen was sent in. The hospital reported to have budgeted about R400 000 to procure own laundry machines.



The service was outsourced, however supervision was done by departmental staff and the equipment belongs to the facility. The Committee noted with concern that the hospital has outsourced its catering services and spends R890 000 per month on food services.



  1. Cramond Clinic


This clinic was built by the municipality in 1997. The Committee noted that the clinic is extremely small. The average headcount is 50 to 200 patients per day. The Operational Manager reported that land has been identified to build a new clinic. Additional infrastructure challenges relate to overcrowding, insufficient ablution facilities, lack of a storeroom, small entrance, and an uncovered waiting area. In terms of a shelter for the waiting area, the infrastructure department committed to providing the clinic with a temporary shelter.


Services offered at the facility include, Ante-natal Care, Child health and youth Services, Community outreach services, Emergency services, HIV Counselling, Testing and treatment, Management of Chronic Diseases, Management of Communicable Diseases, Maternity (Emergency) and Post-Natal Care, Medical Male Circumcision (MMC), Mental Health, Nutrition, Prevention of Mother to Child Transmission of HIV and Aids, TB Screening and Management, Treatment of Minor Ailments, Treatment of Sexually Transmitted Infections, and Women’s Health and Family Planning.


There are five consulting rooms; emergency room, MCWH, acute, chronic and counselling room. There is no dedicated pharmacy assistant and data capturer. Currently, non-clinical officials are assisting with pharmacy duties.  The Committee commended the clinic on its pharmacy that is fully stocked and organized despite not having pharmacy personnel.


The Operational Manager indicated that the clinic has received several awards despite its infrastructural challenges.


  1. Gcumisa Clinic


The average daily headcount in this facility is between 200 and 300 patients. The Committee noted with concern the congestion, uncovered waiting area, IT system not working and the generator has not been working for two months.  The clinic does not have a pharmacy assistant, currently being supported by support staff. In terms of medicine availability, the clinic does not have any stock-outs. The former nurses’ residence has been converted into an ARV clinic. As part of innovation, the clinic uses a digital pen, which converts handwritten information into digital data.


At the chronic section, the Committee observed with concern that patients are exposed to all weather conditions as the waiting area is not covered. Other challenges highlighted include inadequate waiting area; lack of an isolation area; security guardhouse is not ideal; facility grounds not paved; shortage of staff; gardener doing porter’s duties without doing proper job evaluation; water interruptions and delays in the delivery of water by the municipality; and lack of services on weekends and after hours.


  1. Appelsbosch Hospital


The Committee met with the following officials:

Mr T Gwele: Chief Executive Officer

Dr EH Edwards: Medical Manager

Mrs MT Zondo: Deputy Nursing Manager

Mr L Motlohi: Finance Manager

Mr FW Khomo: Systems Manager

Mr TN Ngubane: Human Resource Manager


The Chief Executive Officer, Mr T Gwele briefed the Committee and noted that Appelsbosch Hospital is a district hospital, situated at uMshwathi sub-district and falls under uMgungundlovu District.  Appelsbosch serves a population of 106 374, consisting of 50 483 males and 55 891 females. There are eight clinics and two mobile clinics that are supported by Appelsbosch Hospital. 


Services offered at Appelsbosch Hospital include, Accident and Emergency Medicine, Internal Medicine, Paediatrics, Obstetrics and Gynaecology, Anaesthesia, Psychiatry, Radiology, Pathology Services, Surgery-Obstetric and minor surgical cases and Pharmaceutical Services.


Achievements for the Appelsbosch were highlighted as follows:

  • All clinics and private sector industry such as UCL and Illovo have been registered as CCMDD pick-up points.
  • The Neonatal Ward has been accredited a Gold Status.
  • There is an electronic Health Patient Registration System at the Gateway Clinic.
  • Youth Services are provided at the ART Clinic.
  • The facility is accredited with KINC Status.
  • The facility achieved a Gold Status in Paediatric Ward Assessment
  • Three Speciality Nurses were trained successfully.
  • The facility achieved a bronze status on caesarean section audits.


Challenges were highlighted as follows:

  • There is a high influx of cross border patients in OPD resulting in long waiting times and increased complaints.
  • The poor infrastructure, which leads to difficulty in isolation of infectious from non-infectious conditions.
  • Limited space in all service areas.
  • Staff shortage of both clinical and non-clinical.
  • There are water shortages.
  • Limited budget, which does not meet the facility needs.
  • Renovation programme has failed and in some areas it left things half done or worse than before.
  • The maternity ward has a number of challenges including the following:
  • The maternity ward structure makes it impossible to observe patients when the nurses are in the nurses’ station which jeopardises patients’ safety.
  • Bed inspection does not meet the infection control standard specification.  The space is less than 1.5 m between patients.
  • The three-bedded Labour Ward is very small and congested.
  • Teenage pregnancy is very high (34% of deliveries) which leads to high Caesarean section rate.
  • There are EMS delays which lead to a high rate of babies born before arrival at the hospital and delivery complications.
  • No isolation rooms at the paediatric unit.
  • No boarder mothers’ quarters.
  • Malnourished babies arrive late at the facility for help and die within 24 hours of admission.
  • OPD mixes all categories of patients (adults, children, medical, surgical and mentally ill) in one area due to limited space.
  • OPD patients waiting area is not adequate, usually patients overflow into the corridors and this becomes a big challenge on days when the weather is bad.
  • Poor ventilation at the OPD.
  • OPD has insufficient number of rooms to accommodate nurses and doctors.


Committee Observations:



The Committee noted that there were no proper beds at casualty.  Consulting rooms are not sufficient; doctors share one consulting room which presents issues of privacy and confidentiality.


Filing and record keeping

The filing room is filled to capacity; however, it is well organized as there are no files on the floor. The system is manual.



Storage and working area is inadequate; the facility should keep two months of stock however space does not allow. Dispensing windows are insufficient, there is a shortage of staff; most staff members are close to retirement; and the lack of transport for community service officials to do outreach programmes.



It is an in-house laundry. All machines are working. Linen is sufficient, only in need of additional winter sheets.



The generator is in working condition and it is tested weekly.



The service is partly outsourced, at a cost of R160 000 per month. The Committee noted that the kitchen was clean and organized.


Patients’ complaints

Patients complained of the long waiting time; that doctors do rounds first before consulting outpatients; inadequate number of consulting doctors; and that on-call doctors do not show up when called.


  1. Mpophomeni Clinic


The Committee met with the following officials:

Mr Themba J Yaka: Acting Operations Manager

Mr Nkululeko Mkhize: Assistant Director – Finance

Mr Siyabulela Mgwatyu: District Finance Manager

Ms Ntsikie Ragane: CDC Manager

Miss TS Hadebe: Senior Communications Practitioner

Mrs MT Zulu: Deputy Director – NHI

Mr Sibusiso Mhlongo: Chief Construction Project Manager

Ms Zondo Mzwandile: M&E Manager

Mr Henry Sbongiseni Dlamini: Public Relations Officer – Northdale Hospital

Mr BC Maphanga: Chief Executive Officer – Northdale Hospital

Ms Sandra J Moody: ANM – Primary Health Care

Ms NM Zuma-Mkhonza: District Director


Ms Moody briefed the Committee and highlighted that Mpophomeni Clinic is situated in Ward 10, uMngeni local municipality.  It has a catchment population of 41 006 which includes municipal wards eight, nine and 11.  It is a category C clinic which operates seven days a week and 24 hours a day including public holidays.  Maternity services are provided 24 hours a day with an average of 15-20 normal deliveries a month.


Comprehensive PHC services offered include, acute services (minor ailments), chronic services (NCD and CDC), Maternal Child and Women’s Health Services and Nutrition (MCWH&N), 24-hour maternity services, adolescent and youth friendly services and allied services.


Challenges highlighted were as follows:

  • Infrastructure: the clinic is small and cannot accommodate all patients due to the growing population and burden of disease.

There is no archiving space.

  • Staff shortages: there is no full-time employed Operational Manager. The organisational structure of the clinic has not been reviewed in a long time.
  • High teenage pregnancy.
  • High incidence rate of HIV and AIDS.


The Committee noted that the clinic was small and overcrowded, the waiting area is small and the building was old and there was a need for a new clinic and or community health centre.


The Committee had an interaction with patients who complained that at times they are turned back without their medication which result in them defaulting. The use of manual patient record system results in numerous challenges, including: files being lost, misplaced and resulting in long waiting times. Patients complained that equipment is not sterilized and tests results are problematic.


  1. Umgeni Psychiatric Hospital


The Committee held discussions with the following officials:

Mr Bonginkosi Ndlovu: Hospital Board Chairperson

Ms NE Ndlovu: Chief Executive Officer

Mr ES Mgwaba: Chief Human Resources Manager

Dr Collins Nwokedi: Medical Officer

Dr Vanessa Bhika: Medical Officer

Mr RBN Chirwa: HROS

Dr Nikiwe N Hongo: Director – Mental Health

Ms FW Hongwane: Manager – Nursing

Mrs ST Chule: Assistant Nursing Manager

Ms EN Zondi: Assistant Manager – Monitoring and Evaluation

Mr SL Mjaja: Assistant Manager – Pharmaceutical Services

Ms AJ Xulu: Quality Assistant Manager

Mr Bonginkosi Gwananda: Manager – Labour Relations

Mr MR Green: Deputy Director – Planning, Monitoring and Evaluation

Mr Mxolisi Zuma: Chief Artisan

Mr MV Ngcobo: AD – Systems

Ms Madlala Mabhuta: Assistant Manager – Nursing

Mrs A Biyase, Public Relations Officer

Mr SC Ngcobo: A&M


Ms Ndlovu, CEO, briefed the Committee and noted that Umgeni Psychiatric Hospital is within uMgungundlovu District and is providing care, treatment and rehabilitation to Mental Health Care Users from all over KwaZulu-Natal Province.  The hospital caters for people who are mentally challenged and some have physical problems like diabetes, spastic limbs, blindness and speech problems.


The hospital started as a Military Hospital and a convalescent deport in 1939 which was closed down in 1945.  In 1947, the provincial department took over and converted it to a mental institution for the Intellectually Challenged Users.  In April 1950, the name was changed to Umgeni Waterfall Institution.  In 1979, the government provided a considerable number of new buildings and equipment to the existing Umgeni Hospital.  The new wing of the hospital comprising of wards C, D1, D2, E and new central dining room, nurses’ residence, physiotherapy department, dispensary and adjacent offices. 


Services offered at the facility include in-patient services (intellectually challenged), Out-patient Services (referred in, down referrals and self-referrals), Social Services, Rehabilitative Services (Occupational therapy and Physiotherapy), Allied Health Services (Pharmaceutical services, dietetics and psychology), and Occupational Health Services (Wellness Programme).


Ms Ndlovu indicated that they are unable to conduct outreach programmes due to staff shortages. The hospital’s main cost drivers are nutritional supplements, medicines and disposable nappies. On HR, the CEO indicated the shortage of security personnel. On infrastructure needs, the heating and cooling system needs to be upgraded, fire detection system installed and perimeter fencing repaired. The facility has challenges with the sewerage system. The infrastructure department committed to liaise with the municipality in this regard.


The Committee went on a walkabout and noted that the MHCUs were well taken care of and offered stimulation programmes as part of their therapy.  They had won a number of awards for carpets and blankets made for the Royal Show. However, there was a shortage of Occupational Therapists (OTs) and OT Assistants as well as enrolled nurses and enrolled nurse assistants. The Committee was impressed that the linen services were in-sourced. The workshop was functional.


  1. Imbalenhle Community Health Centre


The Committee met with the following officials at the Centre:

Mrs XNT Mtunzi: Chief Executive Officer

Dr AA Fowole: Medical Manager

Mr SM Mkhize: Human Resource Manager

Mrs NPN Mthembu: Finance Manager

Mr KN Ngcobo: Systems Manager

Mrs NM Chonco: Assistant Nursing Manager for Clinics

Mr Sibusiso Mhlongo: Chief Construction Project Manager

Mrs MT Zulu: Deputy Director – NHI


Mrs Mtunzi, CEO, briefed the Committee and highlighted that Imbalenhle CHC is strategically located and serves the Imbali community and its surroundings.  It is situated 1.6 km from Edendale Hospital with an estimated population of 105 533 and unemployment rate of 42%.  Patients from other parts of Pietermaritzburg prefer to come to the clinic for their health care needs. The average headcount per month is approximately 25 000.  The CHC renders 24-hour medical, nursing and maternity.  Mrs Mtunzi noted that there is pressure to keep pace with the growing needs for services.


The CHC’s ARV clinic is still supported by Khethimpilo in terms of funding and staff salaries. Imbalenhle CHC supports seven ex municipality clinics which are Impelwenhle, Azalea, Willowfountain, Esigodini, Ashdown, Grange, Snating and one mobile unit.  The facility refers patients to Edendale Hospital. 


Services offered at the facility include Chronic medical hour 24 hour emergency (including maternity services) covered by medical officers, Treatment of acute medical conditions, stabilisation and referral to hospitals, Maternal, Child, Women’s Health and Nutrition (MCWH and N) including low risk deliveries, ANC and Postnatal Care, HIV and Aids, sexually transmitted infections and Tuberculosis (HAST), Mental health clinic where about an average of 430 psychiatric patients are treated every month, Minor surgical procedures, Pharmaceutical services, Dental services, X-ray and ultrasound services, Occupational health services, Physiotherapy services, Dietetic services, Medical Male Circumcision (MMC), HIV testing services (HST), Community Outreach (School Health services, Family Health Team and CCG’s), Disability Grant assessment (in collaboration with SASSA) and the Centralized Chronic Medicines Distribution and Dispensation (CCMDD) programme.


The facility received the following awards for its best performance:

  • Service excellence award district – Best performing CHC in NCS 2015.
  • MASEA Best Performing CHC NCS 2016/16.
  • MASEA Certificate of commendation NCS 2016/17.
  • Gold Status obtained in 2016/17 for being an Ideal Clinic.
  • Most improved CHC in CCMDD implementation in 2016/17.
  • The facility has also access to the internet and web-email.
  • The facility has implemented the electronic patient record system and 9 303 patients have been registered on the system so far.


The following were indicated as challenges the facility is facing:

  • The expenditure of the CHC exceeds allocated budget, the main cost driver being ARVs.
  • COE is underfunded; it is not allocated according to the organisational structure of the facility.
  • There is no segregation of duties due to non-filling of non-clinical posts especially in SCM and HR.
  • No approval of filling of vacant lower category nursing staff posts.
  • Inadequate storage space for pharmaceutical supplies.
  • Inadequate parking for staff and patients.
  • Inadequate office space.
  • Patients’ privacy and confidentiality is compromised due to shortage of consulting rooms.
  • There is poor security coverage and there are delays in finalising security contracts and non-approval of CCTV installation.


Committee Observations:



The pharmacy is small and storage space is inadequate. Pharmacists are unable to conduct their supervisory work and also conduct outreach programmes due to staff shortages. There are challenges with CCMDD services after a new service provider was appointed.






Filing and record keeping

The CEO indicated that there are challenges with the tracking of patients due to address changes. At times the data capturers are unable to logon to the HPRS when it is off line. There is a shortage of clerks.



The Committee noticed that the staff parking is inadequate.


  1. Umlazi V Clinic


The Committee conducted an un-announced visit at Umlazi V Clinic, under the jurisdiction of eThekwini Metropolitan Municipality. The Committee and held discussions with the following officials:

Mr KM Myeni: Operations Manager

Mrs N Mavuso: Nursing Manager


The Committee noted the following:

  • There are major infrastructure challenges; the clinic is old (built in 1953), narrow and overcrowded, and is located in an alley.
  • Inadequate consulting rooms, compromising patients’ health, privacy and confidentially as two nurses share one consulting room.
  • An ambulance cannot access the facility. Patients are carried in stretchers to the ambulance which has to park in the road.
  • Due to the lack of space, TB patients, children, babies and pregnant women wait in the same area; infection control and prevention is compromised.
  • There is no dedicated space for weighing babies; the nutritional advisor also uses the same space.
  • Due to infrastructure challenges, there is no space for record keeping, resulting in files for minor ailments being kept outside the facility.
  • Some of the toilets are not functioning due to a burst pipe.
  • There is no water back-up system.
  • The kitchen is small and leaking.
  • Only one school nurse conducts outreach programmes due to staff shortages.
  • There is no dedicated pharmacy assistant.
  • The dispensary is small, excess stock is kept on the floor.
  • There is an NGO based at the clinic that assists with HCT and screening.


  1. Cato Manor Community Health Centre


The Committee met with the following officials at Cato Manor Community Health Centre (CHC):

Miss Bazamile E Mtshali: Chairperson of the Clinic Committee

Mr L Thoko: Community facilitator and Clinic Committee Deputy Secretary

Mrs MT Zulu: Deputy Director – NHI

Miss CN Nzeku: Assistant Nursing Manager

Mrs Zinhle Buthelezi: Deputy Head –  South

Mrs Hope Ngobna: Senior Manager

Mrs Siziwe Chonco: Nursing Services Manager

Dr V Mubaiwa; Chief Director

Mr Selby Xulu: Reserve Supervisor


Cato Manor CHC is situated in a densely populated area with high unemployment rate and low socio-economic conditions.  The total catchment population is 61 921.  The area is highly burdened by communicable diseases such as HIV and Aids, TB, STI, malnutrition and teenage pregnancy.  The CHC serves Wards 20, 30 and 101.  The clinic was opened in March 2004.  In April 2005, a 24-hour midwifery Obstetric Unit was commissioned by the provincial department. Operational services are done by municipality, through the Service Level Agreement that was signed by the province and the municipality.  These services include cleaning, security services, and maintenance of the infrastructure since it belongs to the municipality. Two challenges the facility is faced with, is its joint management (province and municipality) and the shortage of staff.



Package of services offered at the facility include, maternity services, mental health services - psychologists from the District visit once a week, Dental /Oral Health services, Rehabilitation services, HAST, MMC, ARV, PMTCT, Maternal and Child Health Services, Social Services, Mobile Clinic covering taxi ranks in central town, Family outreach team, School health and CCGs, Adolescent youth friendly and Occupational health.


Committee Observations:



The Committee had a walkabout at the facility and was informed that the facility opens at 06:00 am.  All patients are admitted in one reception area where the registration is done and they are triaged. 


Filing and record keeping

The filing system is currently being migrated to the electronic Health Patient Registration System. The patient registration system with assist in curbing duplication and loss of files. There are only two clerks that services the facility which is not enough to run the system.  For a year there has been a moratorium on the appointment of administration staff which led to staff shortages and the backlog in the registration of patients.


Labour Ward

The Committee was informed that there are staff shortages in this ward; with only two nurses on duty at the antenatal section.  There are two labour rooms which are well equipped


Dental Clinic

The dental clinic operates from Mondays to Fridays.  Only teeth extractions are performed at the clinic and other dental services are not run due to the lack of a dental chair. The dentist indicated that the dental chair was not fully functional and that a new chair was being procured.


  1. Prince Cyril Zulu Communicable Diseases Centre


The Committee met the following officials at the facility:

Mr Nkululeko Mkhize: Assistant Director – Office of the MEC

Mrs MT Zulu: Deputy Director (NHI)

Mrs Zinhle Buthelezi: Deputy Head – South (eThekwini Municipality)

Mrs Hope Ngobo: Senior Manager

Mrs Siviwe Chonco: Nursing Services Manager

Dr V Mubaiwa: Chief Director


Prince Cyril Zulu Communicable Diseases Centre is located at the busy Warwick Triangle surrounded by major taxi ranks, railway station, major bus ranks and informal traders.  It was opened in 2001.  The catchment population is 47 736 which constitutes 41 876 adults and 5860 children.  The facility services ward 28 and 32 but also provides services to a large population from all over eThekwini Metro, nearby districts, provinces and mobile population.  The facility operates eight hours a day, Monday to Friday.


This is a specialised facility which largely provides treatment and care for communicable diseases (HIV testing services, antiretroviral therapy, MMC, Sexually Transmitted Diseases (STI) and Tuberculosis (TB), Contraception, Screening and treatment for NCD’s and X-ray services


The challenge is with regard to patients from neighbouring provinces such as the Eastern Cape which result in loss to follow-up. Currently the x-ray machine is not functional, x-ray services are provided by a mobile truck.   


  1. Addington Hospital


The Committee took a decision to visit the Oncology Unit at Addington Hospital following the report of the South African Human Rights Commission on the inadequate services provided in that unit. The South African Human Rights Commission made the following findings:

  • The Respondents (Addington Hospital, KwaZulu Natal Provincial Department of Health and Member of the Executive Council for Health in KZN) have violated the rights of the patients with cancer at Addington Hospital to have access to health care services as a result of their failure to comply with applicable norms and standards set out in legislation and policies by failing to:
  • Evaluate and identify the need for functional equipment such as CT scanners and Varian Rapid Arc Linear Accelerator (VRALA) machines within reasonable time;
  • Failing to procure, maintain and or put in place adequate functional equipment such as CT scanners within reasonable time;
  • Failing to recruit and retain suitably qualified staff including oncologists, radiotherapists, medical officers and oncology nursing staff in the province and
  • Failing to monitor and evaluate the health needs of oncology patients in the province in time to implement appropriate interim models such as sufficient Public-Private Partnerships to meet needs.
  • The Respondents failure to provide access to adequate oncology services also violate interconnected inter-dependent rights to human dignity and life of affected patients.


The Committee therefore wanted to assess progress made since its engagement with the South African Human Rights Commission, KZN MEC for Health, Dr SM Dhlomo and the Minister of Health, Dr A Motsoaledi.


The Committee met with the KZN MEC for Health, Dr SM Dhlomo and the following officials:

Dr M Gumede: Acting HOD

Dr M Ndlangisa: Chief Executive Officer

Mrs NP Nzuza: Deputy Director – Finance

Ms Wanda Thulisile: Deputy Nursing Manager

Dr A Aron: Senior Medical Manager

Ms LN Mackenzie: Assistant Nursing Manager

Mr ET Chairo: Acting Director – Engineering

Ms NH Ndwandwe: Chief Quality Surveyor

Mr BN Ndlovu: Candidate Mechanical Engineer

Mr FN Zuma

Mr CH Myeza: Systems Manager

Dr NP Zuma: Radiation Oncologist

Mrs T Hlengwa: Radiotherapy Unit Manager

Ms C Carter: Monitoring and Evaluation Manager

Mr Zamokuhle Zondi: Head of Ministry

Mr Sibusiso T Mhlongo: Chief construction project manager

Mr Mach R Green: Deputy Director – Planning, Monitoring and Evaluation

Mrs Zinhle Buthelezi: Deputy Health – Municipality

Mrs Hope Ngobese: Senior Manager – PHC

Mrs Buyelwa Biyela: Manager – Pharmaceutical Services

Mr J Mndebele: CD – DHS

Ms NM Zuma-Mkhonza: District Director

Dr T Moji:ADDG – DHS

Ms N Ngcobo: DA Caucus Research Officer


The Committee was taken through the Oncology Unit. Dr Zuma explained the processes of testing and treating cancer patients.  It was noted that one machine was procured and one was repaired and is fully functional. 


The challenges noted were that Addington Hospital was gazetted as a regional hospital and therefore oncology should have never formed part of the hospital as it is tertiary hospital function.  Oncology was also not part of the staff establishment.  It was also highlighted that even the budget of the hospital did not relate to the structure of the facility.  The unit remained short-staffed as it requires an additional 16 professionals.


  1. Summary of Findings per Health Facility


  1. Mpumuza Clinic
  • Clinic is small to accommodate the growing population.
  • Shortage of medicines.
  • Patient waiting area does not have a shelter, patients are exposed to all weather conditions.
  • Staff shortages leading to long waiting time.
  • Emergency Medical equipment was last calibrated in 2014/15.
  • There is no ambulance available at the facility after 17:00.


  1. Edendale Hospital
  • Shortage of transport for outreach programmes, particularly for pharmacy assistants to support clinics.
  • Maintenance of medical equipment is a challenge.
  • Shortage of staff.
  • There is a shortage of consulting rooms and patients’ rights to privacy and confidentiality are violated.
  • Waiting time for medicines is long.


  1. Fort Napier Hospital
  • There are staff shortages at the facility, particularly shortage of psychiatrists leading to seven months long waiting list.
  • There are infrastructural challenges, the facility is old.
  • Laundry machines are old and are always breaking down.
  • Laundry staff are not being paid equivalent to the staff of the central laundry (Cato Manor).


  1. Grey’s Hospital
  • There are staff shortages at the facility.
  • There is a challenge with the referral system as some patients come to the facility without referral letters.
  • The radiation machine is old and outdated.
  • The Committee noted one radiation machine that is not desirable.




  1. Cramond Clinic
  • Facility is very small and there is a gross shortage of space
  • There are staff shortages at the facility.
  • Patient waiting area does not have a shelter.


  1. Gcumisa Clinic
  • There are staff shortages at the facility.
  • The back-up generator has not been working for two months.
  • Patient waiting area does not have a shelter.
  • The Committee noted with concern the non-functioning of the generator at the facility.


  1. Appelsbosch District Hospital
  • There are staff shortages at the facility.
  • Maternity wards non-compliant with spacing requirements.
  • HIV and Aids remains the leading cause of death.


  1. Mpophomeni Clinic
  • The organisational structure of the facility has not been reviewed in a long time.
  • There are infrastructure challenges; the facility is small and does not accommodate the health needs of the community.
  • Sometimes patients are turned back without their treatment from the facility which increases defaulter rate.
  • The filing system is not working properly and some patient files get lost.
  • There are staff shortages at the facility.
  • The Committee was informed by the community that medical test instruments are not sterilised, which affect the quality of results.
  • The facility has challenges with the sewerage system.





  1. Umgeni Psychiatric Hospital
  • The facility admits patients who are abandoned by their families and then are bought to the facilities by the South African Police Services.
  • Families do not visit the patients and some were left at the facility when they were still very young and have not had any visitation since.
  • There are staff shortages at the facility including OTs.
  • The facility has challenges with the sewerage system.


  1. Imbalenhle Community Health Centre
  • There is no parking space.
  • There are staff shortages.
  • The facility is overspending on ARVs.


  1. Umlazi V Clinic
  • There are space constraints at the facility as it is very small.
  • There is no proper entrance to the facility.
  • Ambulances cannot access the clinic.
  • Multiple patients are seen in one consulting room; this compromises patients’ privacy.
  • TB patients, babies, children and pregnant women wait in one area.
  • Sewerage system is blocked and spilling over.


  1. Cato Manor Community Health Centre
  • There is joint management between the province and the municipality which results in challenges of accountability.


  1. Prince Cyril Zulu Communicable Diseases
  • The province is attending to patients from neighbouring provinces such as the Eastern Cape which makes it difficult to trace them.
  • There are staff shortages at the facility.




  1. Addington Hospital
  • The hospital was gazetted as a regional hospital but has to provide oncology services, which are not supposed to be offered at a regional hospital.
  • The budget is inadequate to cater for oncology services.
  • There are staff shortages at the facility.


  1. Meeting with the MEC


Having concluded its oversight in KwaZulu-Natal Province, the Committee held a meeting with the MEC and highlighted the following observations and findings:

  • Human resources:  Staff shortages is a major challenge across the district, both clinical and non-clinical staff. The Committee raised concern around the moratorium on the filling of non-clinical posts. There is a mismatch between the organisational structures and the actual human resources needs of facilities. Organisational structures need to be reviewed to ensure alignment. HR issues in all the health facilities visited Fort Napier is a concern. For instance, in Fort Napier Psychiatric Hospital it was indicated that due to the scarcity of forensic psychiatrists in the province it is unable to assess patients timeously who are awaiting trial.
  • Infrastructure: The Committee expressed concern on the state of infrastructure in UMgungundlovu and had expected to see significant improvements as an NHI pilot site. PHC facilities were found to be inadequate.  Some facilities do not meet the design and layout requirements for set infrastructure standards. Umlazi V Clinic for instance, requires urgent intervention; babies, children, pregnant women and TB patients sit in the same waiting area. The clinic is also not maintained, the sewerage system is blocked and spilling over.  There is no parking space and access for ambulance. There is a general lack of space, overcrowding and lack of privacy and confidentiality. The Committee visited a smaller clinic, Cramond clinic, which also needs to be expanded, but it is doing better in terms of its functionality. Mpumuza clinic’s infrastructural issues is also a concern; the size does not accommodate the population as it services four Wards. There is a need to build a new clinic or CHC.
  • The Committee indicated that in 2012 government resolved to begin to insource some services (laundry, security and kitchen). Some of the outsourcing of food services particularly in Grey’s Hospital is not necessary as half of the personnel and all the equipment belongs to the department, the service provider only provides half of the personnel and food. Appelsbosch Hospital’s insourced kitchen is working well. Whilst in Appelsbosch Hospital, the Committee noted with concern that one staff member is still at level one.
  • Laundry services: The turnaround time of linen at the central laundry is a concern, and facilities do not get what they brought in for laundering, even if new linen was sent it does not return as it was. At Fort Napier Hospital, laundry machines are old and outdated and are also servicing other facilities, there is a need for a total revamp.
  • High teenage pregnancy: The Committee noted with concern the high rates of teenage pregnancy in the district, which is a driver of HIV rates and pointed out the need for sustainable programmes, as opposed to once-off campaigns.
  • Issues around Cato Manor CHC: The Committee raised concern about the facility being under joint management as this presents a challenge in terms of accountability. The Committee also indicated the need to properly reclassify Cato Manor CHC as it currently stands between being a clinic and a CHC.
  • Shortage of resources such as vehicles to conduct outreach programmes, particularly the pharmacy assistants.
  • The Committee noted with concern the Edendale oncology machine that constantly breaks down.
  • IT systems and filing systems are inadequate.
  • The Committee appreciates the interventions at Addington Hospital in terms of restoring oncology services, though there is still work to be done.
  • On mental health, the Committee was of the view that decisions are made without involving the facilities.



Comments by the MEC

  • The MEC noted the human resources challenges in terms of training, shortage of oncologists and psychiatrists.
  • IT challenges is a province-wide issue.
  • The MEC indicated that all new equipment is procured with a service plan.
  • The province is implementing a number of programmes such as Operation Sukuma Sakhe and Phila Mntwana centres established to deal with severe malnutrition in children.
  • Issues of teenage pregnancy – a provincial campaign, was launched in June 2016, in Pietermaritzburg in trying to deal with teenage pregnancy.
  • The province is in the process of piloting the insourcing of some services.
  • Umlazi V clinic should have been closed a long time ago, there is a Prince Mshiyeni Gateway Clinic close-by, however the community is resisting the closure of the clinic.


  1. Recommendations

The Committee recommends that the Minister of Health ensures that KZN Provincial Department of Health:

  1. Human Resources
  • Ensure that staff complement in all health facilities is improved upon, by ensuring that clinical and non-clinical positions are filled.
  • Should review organisational structures of health facilities to ensure alignment of programmes with budget structures. As well as ensuring that level 1 posts are abolished.
  • Increase funding for academic training to increase the pool of specialists.
  • Laundry staff salaries should be standardised.
  • Ensure the decentralization of delegations of authority to the district (for clinics and smaller hospitals) and at facility level (tertiary hospitals where there is capacity to implement the delegations).





  1. Financial Management
  • Provincial department should improve on supply chain management processes, with the aim to improve procurement turnaround time, particularly for the procurement of medical equipment.
  • In view of limited resources and huge demands for services, budget priorities should be identified without compromising the delivery of services.
  • Address the centralization of contracts to suppliers who do not have the capacity to supply.  
  • Introduce a tracking system for suppliers to ensure value for money.


  1. Infrastructure
  • Assess the infrastructure requirements of the entire province, particularly primary health care facilities.
  • Prioritise clinics that require urgent intervention with regard to inadequate infrastructure.
  • Urgently address the infrastructure challenges in the following primary health care facilities:
  •  Mpumuza Clinic –   the facility should be converted to a CHC;
  • Cramond Clinic – the facility should be rebuilt; and  
  • Mpophomeni Clinic –  the facility should be converted to a CHC.
  • Erect shelters so that patients do not queue outdoors and be exposed to all weather conditions (in particular at Mpumuza and Gcumisa Clinics).
  • Infrastructure maintenance (structures and equipment) backlogs should be dealt with systematically.
  • Generators should be tested and maintained on a regular basis.
  • Integrate all health infrastructure maintenance plans and ensure that budgets are appropriately ring-fenced and spending levels are maintained.
  • The sewerage system at Umgeni Psychiatric Hospital should be addressed urgently.




  1. Medical equipment
  • Ensure timeous procurement of essential medical equipment.
  • Ensure that Service Maintenance Agreements (with the service provider) are in place for medical equipment so that medical equipment is maintained timeously.
  • Prioritize the maintenance of emergency medical equipment.
  • Calibration of emergency medical equipment should be prioritised on a regular basis.


  1. Pharmaceutical services/ Medicine availability
  • Ensure uninterrupted availability of medicines and supplies in hospitals and clinics.
  • Ensure that hospital pharmacies are properly resourced with regards to staff including pharmacists and pharmacy assistants as well as transport to enable them to conduct outreach services.
  • Ensure that drugs and supplies are available to feeder clinics.


  1. Essential support services
  • The provincial department should insource security, laundry, kitchen and cleaning services.
  • The insourcing of the kitchen services at Grey’s Hospital should be addressed in order to curtail costs.
  • Ensure that laundry machines are upgraded (particularly in Fort Napier Hospital) and maintained, where required to improve supply of linen.
  • Ensure that tertiary hospitals have in-house laundry services to ensure adequate supply and availability of quality linen in these hospitals.
  • Ensure adequate staff at the central laundry to improve turnaround time.


  1. Information Systems
  • Ensure greater investment in IT personnel and infrastructure.
  • The filing and record keeping system of many facilities should be improved upon in order to manage lost files, long waiting time and medico-legal claims.



  1. Governance and leadership
  • The provincial department should address the issue of joint management of health facilities (e.g. Cato Manor CHC) between the province and the municipality to improve on governance and accountability.


  1. Umlazi V Clinic
  • The clinic should be completely closed and patients relocated to the nearest health facility.


Report to be considered.




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