ATC200904: Report of the Select Committee on Petitions and Executive Undertakings on the Hearing of the Matlala Petition Held on 19 February 2020, as Adopted on 02 September 2020
REPORT OF THE SELECT COMMITTEE ON PETITIONS AND EXECUTIVE UNDERTAKINGS ON THE HEARING OF THE MATLALA PETITION HELD ON 19 FEBRUARY 2020, AS ADOPTED ON 02 SEPTEMBER 2020
The Select Committee on Petitions and Executive Undertakings (Committee), having considered the Matlala Petition, referred to the Committee by the Chairperson of the National Council of Provinces (NCOP) on 09 September 2019, for its consideration and resolution, reports as follows:
The Matlala Petition (petition) was submitted to the NCOP by Mr Elcort Matlala (petitioner), submitted on behalf of Dichoeung Clinic Committee.
The petitioner seeks the intervention of the NCOP, relation to the alleged failure by Limpopo Department of Health (the department) to honour its undertaking of building a Community Health Centre (CHC) for the community of Dichoeung in Jane Furse in the Sekhukhune District Municipality, Limpopo Province.
The petitioner alleges the following:
- That, in a meeting held with the community of Dichoeung, the Limpopo Department of Health undertook to build a CHC for the community of Dichoeung in Jane Furse, in the 2018/19 financial year;
- That, without consulting the community of Dichoeung, the department changed the period of building the centre to 2019/20;
- That, the department is not willing to share information with the community of Dichoeung regarding the actual date for the commencement of building the centre; and
- That, the community had sought the intervention of the Presidency and National Department of Health to no avail.
On 19 February 2020, the Committee held a hearing on the petition at Parliament, where the petitioner and relevant stakeholders were invited. The purpose was to afford the petitioner and relevant stakeholders with an opportunity to make first-hand oral submissions in relation to the subject matter of the petition.
- Committee Members and Officials
The following Committee Members were in attendance:
2.1.1 Hon Z V Ncitha, ANC, Eastern Cape (Chairperson);
2.1.2 Hon E M Mthethwa, ANC, Kwa-Zulu Natal;
2.1.3 Hon S Shaikh, ANC, Limpopo;
2.1.4 Hon M P Mmola, ANC, Mpumalanga;
2.1.5 Hon T S C Dodovu, ANC Northern Cape;
2.1.6 Hon G Michalakis, DA, Free State;
2.1.7 Hon C Visser, DA, Northern Cape;
2.1.8 Hon K Motsamai, EFF, Gauteng;
2.1.9 Hon S Zandamela, EFF, Mpumalanga; and
2.1.10 Hon S E Mfayela, IFP, Kwa-Zulu Natal
The following Committee Member tendered his/her apology for being unable to attend the hearing on the petition:
2.1.11 Hon I M Sileku, DA, Western Cape; and
2.1.12 Hon A B Gxoyiya
The following Committee officials were in attendance:
2.1.13 Mr N Mkhize, Committee Secretary;
2.1.14 Adv. T Sterris-Jaffer, Committee Researcher;
2.1.15 Mrs N Fakier, Executive Secretary, and
2.1.16 Mr M Nkwali, Researcher, Office of the Chairperson of the National Council of Provinces.
The following stakeholders were in attendance:
2.2.1 Petitioners, Mr K E Matlala and Mr M N Aphane;
2.2.2 Representatives from the National Department of Health, Mr R Morewane (Chief Director-Principle Health Care); Ms Y Mokgati (Director-Primary Health Branch), Mr S Ngobese (Ministry) and Mr JM Kgatla (Parliamentary Liaison Officer);
2.2.3 Representatives from the Limpopo Department of Health, Dr M Y Dombo. (Deputy Director-General Health Care Services).
- SUBMISSIONS BY THE PETITIONER
In his submission to the Committee, the petitioner Mr K E Matlala (Mr Matlala), submitted that the primary reason they petitioned Parliament, was due to an undertaking made by the Limpopo Department of Health (the department) to build a Community Health Centre (CHC) in the 2018/19 financial year. The Committee was made aware that commitment did not materialise in that financial year, but it was changed without any communication made to them. They only learned about the changes when going through the Municipality Integrated Development Plan (IDP), that it has been moved to the 2019/20 financial year without any reasons.
In addition, Mr Matlala further submitted that since the 2019/20 financial year nothing has been done or communicated to them. They, as the representative of the Dichoeung Clinic Committee have tried to engage with the department through it officials, but drew blank. And it was also difficult for them to trust the department any further, as a result in one of their engagements, they were told that the Office of the MEC of Health was not planning to build any clinic in the 2018/19 financial year due to budget constraints.
Further, Mr Matlala submitted that there was contradiction coming from the province, pointing out that during the State of the Province Address of 2018/19 financial, flyers were distributed, outlining that one of its priorities is to “complete new clinics”. They felt misled and further not trusting the Office of the MEC of Health, hence they ended up petitioning Parliament.
The Committee also heard supplementary submissions from Mr M N Aphane (Mr Aphane), submitted that the matter has been with them since 2007. They were informed that the Dichoeung Clinic was going to be upgraded but the provincial department commissioned a new clinic. The Traditional Council by then wrote to the Office of the MEC of Health who never responded to the letter. They then proceeded and approached the Office the Premier and the Office of the Presidency and both offices did not respond to them.
According to Mr Aphane the situation has impacted negatively on the community health. As a result, the Dichoeung Clinic no longer operates on 24 hour bases as it used to. The services have been downgraded, operating hours have been shortened, which make it impossible for the clinic to operate on weekends, the clinic is understaffed, and it only has three professional nurses.
- SUBMISSIONS BY THE NATIONAL DEPARTMENT OF HEALTH
The oral submissions on behalf of the National Department of Health (the NDoH) was led by Mr R Morewane, Chief Director- District Health Services, indicated that he was delegated to make such submission since he has worked intimately with the Limpopo Department of Health on this matter.
In his submission, Mr Morewane informed the Committee that the Dichoeung Clinic matter came to their attention, when the NDoH received a complaint letter from the petitioners in 2016 about the state of the clinic. Thereafter, the NDoH delegated senior representatives to engage with the community of Dichoeung, to get a historical background of the Dichoeung Clinic and come up with resolution with all the stakeholders. Following that visit, the NDoH then prepared a letter to the Minister of Health, advising that the matter should be processed through the Limpopo Department of Health. The Clinic Committee rejected the Minister’s proposal due to the alleged loss of confidence in the leadership of the Provincial Department of Health (PDoH) on the matter. Mr Morewane notified the Committee that he then took it upon himself to meet with the community of Dichoeung.
Mr Morewane reported, that during the cause of engagement with the community, he picked up that the Dichoeung Clinic was built around 1977, naturally due to age the building has depleted. . According to his own assessment, the site was ideal for the clinic at that time. But pointed out that if you had to expand in terms of infrastructure and cater for the size of the population, he did not see the site being big enough.
He then reported that the upgrading of Dichoeung clinic was initiated during the 2006/2007 financial year. This was after the community meeting took a decision on the site of the clinic on 7 March 2007.The agreement from the same meeting was that Kgoshi Kgoloko of Madibong would provide a site for construction of the new clinic. According to Mr Morewane, this was a unanimous decision. This dispels the allegation that the ward councillors who were aligned to Madibong village and neighbouring villages unilaterally identified the land on the Madibong side for the construction of the clinic.
It was reported that the name of the clinic was based on the understanding that the new clinic was a replacement of Dichoeung Clinic, which was old and dilapidated. The construction of the new clinic meant that the resources that should be received by the old Dichoeung clinic are diverted to the new facility for efficient use of resources.
The objection of on Madibong clinic construction was raised during the implementation phase of the clinic (while the construction was on). The community of Dichoeung felt betrayed and cheated by the Councillors who consented to the building of the clinic in Madibong side. They further felt that the new clinic should not be called Dichoeung since it is in Madibong.Thus the following was suggested: Old clinic must not be closed, it must continue to be operational; the LPDoH should commence with renovations of the old clinic and identification of an appropriate site on Dichoeung side to build a clinic.
Mr Morewane informed about the general principles, that the distance between the old and new clinic is approximately 4 km which is within the national norm. The department does not build health facilities per traditional leadership but for the catchment population. The new Dichoeung/Madibong clinic was able to provide equity of access and service coverage to the catchment population. Madibong and Dichoeung communities are historically the same people under different traditional leadership who have historically shared the social resources such as schools and the old Dichoeung clinic. If the proposed clinic is to be built, it would not necessarily be in Dichoeung, on the basis that it would have to be central to serve all the areas from Magnetheights and Jane Furse areas.
Mr Morewane then outlined the agreement between the NDoH and the clinic committee. It was submitted that the NDoH was involved after the clinic committee had referred the matter to the Minister for intervention. Several meetings were held with the community, Sekhukhune district and the Provincial office in order to find a solution. The following was proposed and agreed during one of the meetings:
- The district office will make a motivation to the province to include the CHC for the people of the areas including Dichoeung. This was to be included in the 2018-2019 financial year;
- Makhuduthamaga Local Municipality to include the new facility in the IDP for 2017/18 to 2018/19; and
- The district to proceed with the refurbishment of the old clinic so that the staff can operate in habitable conditions, while the permanent solution is being sought.
The clinic committee did not agree with the general principles. The clinic committee further rejected the Minister’s proposal that they engage the Limpopo Province Department of Health directly, citing loss of confidence. They indicated that the department’s continued use of the name of their clinic to benefit the “wrong” clinic and that is tantamount to fraud. They demanded that the old clinic should stop using the name Dichoeung, as it is in Madibong. The clinic had produced evidence that the province allocated budget to build the clinic, which made them determined that the clinic must be built.
In concluding his submission, Mr Morewane indicated that the old clinic should have ceased to operate when the new disputed clinic was opened in order to avoid duplication. A CHC was proposed which will support the neighbouring clinics as referral service point for the following villages; Madibong, Dichoeung, Moretsele, Moraba, Vergelegen, Tsehlwaneng and Maphopha etc.
The community was requested to identify a site which is at least three (3) hectares in size, enough to accommodate the CHC.The province was ready to conduct the survey of the identified site to see if it is suitable. The community of Dichoeung is to accept that the new clinic (Madibong) was meant to serve all people that were previously served by the old Dichoeung clinic.
In closing, he outlined that the province had to consider building the CHC for the identified villages around Jane Furse and Magnetheights when the budget for both construction and running costs is available, in line with the prioritisation of the infrastructure needs. The clinic committee to work together with the provincial department of health to address the possible construction of the HCC in the identified area.
5. SUBMISSIONS BY THE LIMPOPO DEPARTMENT OF HEALTH
Dr M Y Dombo (Dr Dombo), Deputy Director-General Health Care Services, led submissions to the Committee on behalf of the Limpopo Department of Health (the Department).
Dr Dombo submitted to the Committee by reiterating and further expanding on what has been covered by Mr R Morewane, representative of the NDoH. In her submission to the Committee, she reported as follows.
According to Dr Dombo, the status of the Dichoeung clinic started in 2007, when the department assessed the facility and found out it warranted an upgrade. Therefore, it was recommended that it should be replaced as it was depleted and found not to be in the best standard. Emanating from that, the community was notified of a consultative meeting. The stakeholder meeting was held in 2007; the meeting that was facilitated by the Traditional Council from that area. Indicating, that various communities from the surrounding areas where in attendance.
Dr Dombo, reported that the issues that were discussed, was on the facilities upgrade or whether the facility should be on the same site. Due to access issues, the gathering indicated that they would prefer a new replacement facility to be in Madibong, which would be easily accessible and serve all people in surrounding areas. Further, according to Dr Dombo, that was the only reason as to why the clinic was not built where the old the facility is, but built in Madibong.
Dr Dombo explained that the new Madibong clinic was a replacement clinic and hence the budget was not a movement budget from the Dichoeung clinic budget and the name still remained “Dichoeung clinic”.
In addition, to her submission, she informed that during the construction of the Madibong clinic, the community of Dichoeung indicated that they were not happy that the replacement facility was now located in Madibong. And therefore requested the department to reverse that decision. Thereafter, the community of Dichoeung was informed that the construction was in an advanced stage and therefore it won’t be possible to reverse the decision. It was further explained to them, the issue of a new facility was discussed and a resolution was taken, that if the CHC was required it was not going to be in Dichoeung. But, it was going to be in conducive area, which will cater for all the communities in the surrounding areas, since service delivery for primary health care, requires that it functions as a referral site for local clinics.
Dr Dombo, reported that all interested stakeholders came together and selected an appropriate site. It was requested that they select a minimum of two sites to the surveyors. It was established in the sub district of Makhuduthamaga Local Municipality, the CHC would be used to serve all those particular areas. Dr Dombo submitted that it was an agreement during that particular time. Unfortunately, even though there was that agreement with those stakeholders in 2009, the community of Dichoeung were not satisfied with the outcome. And it continued to request that the old Dichoeung clinic be upgraded or be replaced.
According to Dr Dombo, the decision made of getting a new site was informed through consultation of various communities surrounding the areas. But the new site could not be built without the approval of the land given to them. Through the Traditional leadership of Kgosho Kgoloko, he wrote to the department and indicated that the site had been identified and it met the norms and standards of three hectares. Dr Dombo, submitting that all these events lead to the replacement of Dichoeung clinic to Madibong.
Dr Dombo submitted, that in 2017, when the NDoH got involved in the matter, the discussion around the CHC was still on the same base, that to serve all the communities concerned and not being specifically serving the Dichoeung village. And therefore, it was agreed that a motivation was needed to be made to the province to consider the building of CHC.And emanating from that meeting, the NDoH and Limpopo Department of Health had a discussion around the feasibility of that. The province submitted that due to budget constraints, it was unable to build such a CHC at that time. The province further submitted, that it was still prioritising for communities that do not have primary health facilities, particularly those that are still being served through mobile clinic services.
In concluding her submissions Dr Dombo, updated on the current status of the old Dichoeung clinic. Reporting, that it is still operating and has a staff compliment. In terms of the staff that is present, there is an operational manager, two professional nurses, one staff nurse, three assistance nurses, data capture and a cleaner. The facility sees around 1500 people a month. The renovation and refurbishment will carry on taking place to make it habitable.
The committee was made aware of the department’s way forward. The CHC in Madibong is in line with national norms and standards of the required 5km radius, so the department will not be moving forward to have another replacement, according to the department books the facility was replaced.
6. OBSERVATIONS AND KEY FINDINGS
The Committee made the following observations and key findings in relation to the various submissions made on the subject matter of the petition:
6.1 According to both the NoDH and the Limpopo Department of Health (substantiated by providing records of minutes of meeting and the credentials of the people who attended the meeting upon request), this was a unanimous decision based on community participation of all the relevant stakeholders.
6.2 The naming of the clinic was based on the understanding that the new clinic was a replacement of the Dichoeung Clinic, which was old and dilapidated. The construction of the new clinic meant that the resources that should be received by the old Dichoeung clinic were diverted to the new facility for a more efficient use of resources.
6.3 With regard to the general principles of building a health care clinic; its size is in line with national standards of 5km, which is within the national norm and will able to provide equity of access and service coverage to the catchment population.
6.4 The new clinic (Madibong) is meant to serve all people that were previously served by the old Dichoeung clinic. The new clinic site was also chosen, on the basis that it would have to be a central and conducive area, which will cater for all the communities in the surrounding areas, since service delivery for primary health care, requires that it functions as a referral site for local clinics.
6.5 The Minister of Health, advised that the matter should be processed through the Limpopo Department of Health.
6.6 The renovation and refurbishment will carry on taking place to old Dichoeung clinic for it to be operational. The CHC in Madibong, is in line with national standards of 5km, and therefore the department will not be having another replacement, according to the department books, the facility was replaced.
7.1 It is recommended the Committee conduct an inspection in loco at the two sites mentioned with the purpose of establishing whether:
7.1.1 The new clinic (Madibong) is centrally located
7.1.2 The new clinic (Madibong) is adequately staffed
7.1.3 There is equity of access for the population in the catchment area.
POINT OF DISCUSION AND TAKE NOTE OF THE FOLLOWING: CURRENT PANDEMIC REGARDING TRAVELLING- MEMO AND FURTHER REVISED PROGRAMME
- That the National Department of Health (NDoH) conduct a thorough investigation into the complaints raised by the petitioner, whether this was a unanimous decision based on community participation of all the relevant stakeholders. The investigation by the NDoH is to take into account the following:
- Whether the Dichoeung clinic resources were diverted to the new facility for a more efficient use of resources
- With regard to the general principles of building a health care clinic; whether its size is in line with national standards of 5km, which is within the national norm and will able to provide equity of access and service coverage to the catchment population.
- The Committee is to conduct an inspection in loco at both the new clinic (Madibong) and the old Dichoeung clinic, before the end of the current financial year, in an effort to determine the progress made in the investigation made by the NDoH.
- Upon adoption of the Report, the House refer the investigations made by the NDoH to the Limpopo Department of Health. for further oversight and implementation of recommendations made during investigations referred to in 8.1.1 and 8.1.2 and inspection in loco conduct by the Committee.Thereafther request a progress report on the implementation of recommendations made, within 90 days of the tabling of this report in the House.
Report to be considered
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