The Select Committee on Social Services undertook a study tour to the Northern Cape Province from 08 – 12 August 2005. The purpose of the study tour was for the Committee to exercise its oversight function, as mandated by the Constitution. The primary objectives of the provincial visits included:

• To conduct oversight over the management and quality of services rendered in respect to social development, health and home affairs.
• To inspect various health, social development and Home Affairs facilities, in order to determine the state of physical infrastructure and equipment.

• Identify progress made and challenges that are being experienced by all the stakeholders.

Foreword by the MEC

The Select Committee on Social Services met with the Member of the Executive Council (MEC): Social Services and Population Development, Mr Ackerwaray, on Monday 08 August 2005.

The MEC informed the Committee that the presentation to be given is not to analyze the Department, but to ascertain how the activities were implemented. The department, the MEC stated, took a strategic approach to look at the internal environment, i.o.w. Its capability. The department also had to take a look at the external factors, which includes the policies, which affects the department. The service delivery structures had to be looked at, e.g. social workers, to address the vacancy rate, the physical needs (e.g. availability of computers, fax machines etc.). The devolution of authority will form an important part of this process, and managers will have to be to take responsibility for their actions.

The MEC noted some specifics as well. These include: the number of backlogs with regard to the grant processing of grant applications was reduced from 16000 to 2000. The turn-around times, which includes the appropriateness of facilities, where the department, as stated by the MEC, has done very well.

The MEC stated that the finances has stabilized, backlogs have been eradicated, and staff are motivated.

For 2005 the MEC noted that the infrastructure have to be in place when the SA Social Security Agency (SASSA) is operational in 2006. Focus will be placed on intervention programmes e.g. substance abuse. The state of the department and NGO’s will have to be looked at. The department also increased the subsidy to NGO’s to 50% to enable them to do their work effectively. The department will also be looking to minimize the internal fraud and corruption.

The HOD gave a brief summary on the vision and mission of the department.

The HOD highlighted that the challenges faced by the department are many and diverse, and in saying this, the department made a concerted effort to roll out programs to the rural and vulnerable communities of the Province.

Human Resource and Management and Development

The HOD stated that 100 persons were appointed in Social Auxiliary Work Learnerships. The Department started giving stipends of R500 per month to the 289 volunteers in their Victim Empowerment Programs. Isolabantwana etc. The department has also implemented the Social Work Retention Strategy and 22 Probation and Assistant probation Officers have been appointed in their social crime prevention programs.

Social Assistance Grants

The HOD noted that backlogs in grant processing of grant applications have been reduced from about 16000 to 1721 and the processing of the huge backlogs in appeal cases have been reduced to about 90 cases.

Achievements include:

• The province’s Professional Foster Care Program is rated as the best practice model in the country for family preservation
• The Isobalantwana Project and the Neighbour-Helping-Neighbour Campaign has been rolled out to several towns in support of vulnerable children.
• An additional 15 Early Childhood Development Centers have been registered and the subsidy has increased by 30%
• Funding for services for the aged increased from R78 per person to R120 per person.
• The development of a Mini Drug Master Plan.
• An Elder Persons forum has been established in the Pixley-ka- Seme region.
• Resources have been allocated to start the first Multi-purpose Centre at Resthaven

Development Implementation Support Services

The HOD stated that the focus areas of the department for the 2005/06 financial year include the following:

• addressing the socio-economic problems leading to unemployment, poverty and HIV & AIDS.
• The facilitation and implementation of the poverty relief program.
• The establishment of a new community based economical projects and the strengthening of existing ones.
• The implementation of new poverty relief initiatives
• The provision of social development services to women, children, youth, disabled persons, orphans, and children infected and affected by HIV and AIDS.

Food Security

The HOD stated that the major focus of this programme would entail:

Food parcel distribution and food gardens, where the targeted group will be 9550 households. Drop-in-Centres, and at these centers there will be HIV and AIDS awareness and the provision of nutritious meals. Another targeted service will be the provision of nutritious supplements, the payment of stipends, the establishment of child care forums.

Children/Youth Awaiting Trial

The number of young people entering the criminal justice system in the province range between 279 – 290 per month. Probation Officers in the different magisterial districts are assessing all these young people, in order to determine appropriate placement options.

The HOD informed Members on the statistics regarding the referral of young people who are being assessed:

Residential Care Placement is being implemented as a last resort and emphasis is being placed on community based intervention options in terms of life skills development and support to young people and their families.

The HOD stated that there are currently 12 child-headed households in the Pixley-ka-Seme Region

• The department responded on the issue of the facilities at pay points and stated that at all pay points there is ablution facilities, cover (tents) for the beneficiaries and water at the various pay points and these pay points are in a 5 km radius form the beneficiaries. The HOD stated that the department is currently busy upgrading pay points further and they working with local government and the churches in the various areas. The department also provides the disabled with wheelchairs (if they need one) or the Service Provider provides. The department stated that on the day of the pay out to beneficiaries the payouts begin at 08:00 in the morning and at 11:00 all pay points are finished with payments.
• There are 228 pay points in the province. There are security at these pay points, they are fenced and CPS are present. Community volunteers are present and they are trained in customer care, which are provided for by the Service Provider and at the end of the year a year-end function is held for these volunteers. The MEC stated that SAPS have also been asked to drive around at the various pay points on the day of payments, since this is a visible form of prevention. The HOD stated that the only people within the fence are the Service Provider and the beneficiaries, with the result that any other person must do his business outside (e.g. Mzansi)
• The department stated that beneficiaries are advised that grants are paid on different dates. The MEC stated that beneficiaries have a choice and these are: that they can take the cash payment or leave the money where they load the money on to the smart card. The MEC reiterated that it is all about choice.
• The HOD stated that a grant abuse communication strategy is a priority for the department: strategies include, going door to door and report to the department and abuse in the system, where the department will come up with strategies to curb this. The HOD stated that this is very difficult since many of the people are illiterate.
• With regard to the Food Parcels the HOD stated that the province does provide food parcels, but not as many as they use to. The HOD further noted that the department had to link with the department of Agriculture, but this never materialized.
• The HOD stated that the department wants to see a smooth transition of the personnel to the SA Social Security Agency. She noted that the there is an increase in the number of disability grants, the reason being that of the increase in asbestos related cases, the high risk of TB etc.
• The HOD stated that SOCPEN do indicate which beneficiaries’ benefits will expire and these beneficiaries are informed 3 months before it will expire. The MEC stated that the department is committed to make payments on time and not to delay the process.
• The Chairperson enquired whether or not there were any rollovers and the MEC stated that the department is spending accordingly. The MEC further noted that the department frequently meets to discuss the patterns of spending of the department; to determine early warning signs is the system. The MEC said that the department spent 100% of its budget (R1, 2 Billion).
• The HOD stated that the department dealt with the backlogs and that there was a significant increase in the number of backlog cases.

• That the Department implements the Grant Abuse Communication Strategy, because of the many fraud and corruption cases.
• That the Department link with other departments e.g. talks with the Department of Agriculture will have to resume.

Kgalagadi district is a cross-boundary municipality and the Committee met with the two district Regional Managers of Social Services of the Northern Cape and the North West.

The Regional director informed the Committee that the district is served by 51 workers: 27 permanent staff members, 6 contract workers, and 18 learnerships.

Kgalagadi District is served is served by 8 permanent personnel. The Regional Director stated that with the establishment of the SA Social Security Agency (SASSA) some thinking needs to be applied as to the transfer or absorption of the personnel.

It was stated by the department that beneficiaries served in the area, are 2562 compared to 9340 of the district.

The department stated that certain factors influence the access to grants and these include:

• Foreign documents: in the cross border this is very high
• Lack ID’s: In Deben it was an ID campaign was conducted and it was found more than 500 people without ID’s in four days. It can also be contributed to the limited access to Home Affairs services
• Farms that do not have access to Home Affairs services.

The seven pay points serving the Kgalagadi area are well equipped with necessary amenities required for payments with only one which is small for the beneficiaries, this is Deben community hall.

The Welfare/Pension/Cash Pay Committees at all pay points are managed by volunteers of 6-10 people per pay point, with name tags showing their status. At the end of the year the department with CPS gives them gratitude in the form of money (R400) and or a food hamper and this differs from year to year.

The Regional Director informed the Committee that priority was given to low income households who spent less than R200 per person per month and divisions per town were determined by population size and poverty status in the area.

The Regional Director stated that other institutions such as NGO’s, clinics, hospitals, SAPS, Schools, DOTS, home based care workers, municipalities were involved in one or the other way to help with the food distribution and this came in the form of: storage of food, transport, use of telephone etc.

Complaints which the department received included: maize distribution was small, leaking of cooking oil, damaged of hampers, assessment not fair and volunteers victimized.

The Regional Director stated that the challenges regarding the food security includes:

• The needs exceed the supply of hampers
• "Duplicated" services by the departments of Health and Social Services
• Inevitable lengthy explanations to people as to why they do not qualify
• Limited transport for delivery
• Portuguese communities of Dingleton felt left out
• Enforced list of beneficiaries from community leaders

The department stated that the future of the programme would be to establish Drop-in centers for feeding those who do not have food at home, and that these are being piloted. With regard to the Integrated Social Development Services Grant (ISDSG), where this programme use "funds" amongst the beneficiaries of social grants in starting investments into poverty alleviation projects.

The Regional Director informed the Committee that the department relies on NGO’s to render specialized services, which include: Substance abuse service, services to people with disabilities, Early Childhood Development Centers (ECD’s), services to Older Person’s, Victim Empowerment Services.

The Regional Director stated that services to youth awaiting trial are one of the departments early intervention services functions. He further noted that statistics differ from month to month and in most cases only parental care and secure care facilities are being utilized. Youth awaiting trial in the Kgalagadi district have the privilege to being diverted into life skills and educational programs at Moffat Mission, Kuruman who have been funded by the department for this purpose. The probation officer of Kathu also serves the Kuruman Magistrate office and works cross border in this part of the Northern Cape. Re-assessment of youth in prison is being done on request and according to statistics and lately it was only children from the North West province in the Kuruman prison.

With regard to Mental Health Services no organization exists for this service and no exploration is in the process to assess the degree of the need because of shortage of personnel.

Statutory services

Foster care placement: the Regional director informed the Committee that the number of finalized cases are – Kuruman (72) and Deben/Kathu (40); the number of children benefiting – Kuruman (150) and Deben/Kathu (82); and there are no backlogs in either regions

Services to children and families

The department is currently busy with a programme called- Isolabantwa (Eye on the child)- and this programme is in the formation, where an interest group of stakeholders is formed to establish a structure focusing on protection of children.

New emerging NGO’s

Through the Presidential Nodal projects the Kuruman office is facilitating three organizations towards independent status as NGO’s. These projects receive once-off funding staggered for three years.

The challenges, the department stated includes the following:

• Planning for the absorption of the Northern Cape workers after the end of the cross border existence
• Difficulty of accessibility to Home Affairs services
• Resolve the tricky issues of foreign documentation for ID’s and accessibility to grants
• The poverty level that overwhelms our approaches such as income generating projects, food hampers, soup kitchens, etc.
• Stability of experienced, skilled workers to help with the establishment of NGO’s
• The slow establishment of strong NGO’s that can make a difference in helping to manage the social problems the department has
• Businesses exploiting people in terms of the smart cards.

• Mr Sulliman enquired regarding the use of the smart card. The Regional Director stated that the problem in the Northern Cape (NC), i.t.o. Its Service Level Agreement has to come up with value added service. The department has the task to educate people on the use of the smart card. The department must do more regarding training and informing people. With regard to businesses exploiting this system, the regional director stated that that it is difficult to get affidavits from people to identify who these businesses are. He further noted that the SAPS are visible at the pay points.
• With regard to grants there are no long waiting periods. There were backlogs, but now the department is on track and people are working hard to eradicate the backlogs. The district also has a good relationship with the judiciary.
• Ms Lamoela enquired whether there are any shortages with regard to social workers. The regional Director stated that social workers are a scarce skill in the region. The district does not have a policy in place to deal with the issue. He proposed that these social workers be provided with houses in the remote areas.
• The Regional Director stated that 18 auxiliary workers have been trained in the area and bursaries have been given to exceptional persons. A major concern for the region is that when jobs are advertised the department receives very few applications.
• Ms Vilakazi wanted to know whether the department has any link with the Department of Home Affairs (DHA). The Regional Director said that due to the fact that DHA has a shortage of staff, the mindset of officials and the vast area makes it difficult for DHA. The district had a campaign regarding this issue and there are mobile units (1 in Upington and 1 in Kgalagadi) and this must improve.
• The Chairperson raised the issue of drop-in-centres and NGO’s. The Regional Director informed the Committee that that there are no drop-in-centres in the region, but now the province decide where the need is to establish these centres, previously this was done by the national department. He further noted that there are 2 in the province (1 Upington and 1 in the Namaqua region).
• With regard to NGO’s the regional director said that the NGO's are not skilled enough, and the need is for these NGO’s to be sustainable, the reason being that it is risky if these NGO’s is dependent on the state.
• The Chairperson also enquired regarding the Food Parcels. The department stated that the whole process was done through tender (nationally) and provinces just had to distribute the food parcels.
• The department informed the committee that grants are processed on time and the waiting time now is 3 months.
• The Executive Mayor stated that the district had many enquiries regarding burials. The department stated that they use to fund burials to those who could not afford it, but now there are no more funds available to render this service. The Committee undertook to take this issue up with the National Department of Social Development.

• The SC on Social Services stated that they would take up the burial assistance to the poor up with the National Department.

The Regional Director stated that the challenges in the Moshaweng Service Point is that the shortage of staff hampers service delivery and that a normal ratio is 1 social worker: 5000 people and this is the same in Gasegonyana Service Point.

With regard to office accommodation there is a lack for Moshaweng Service Point and efforts taken to secure a building were and are still unsuccessful. Both service points are still accommodated in one building, and as result there is overcrowding of personnel who have to share offices.

In Moshaweng there is 1 subsidized Early Development Childhood center and in Gasegonyana 4.

Children in conflict with the law

The presenter stated that in the Social worker never receives requests for pre-trial reports for children awaiting trial for both Service points

Food security

During the 2003/04 financial year Moshaweng food parcel allocation was 8000 and Gasegonyana 5000. In the 2004/05 financial year Moshaweng received 1250 food parcels and Gasegonyana 750.

The reduction in the food parcels hampered the programme in terms of reaching the majority of the vulnerable people. The regional Director stated that there was no synergy between the Departments of Agriculture and Social Development.

Integrated Social Development Grant (ISDSG)

The Kgalagadi District has been identified to as an area to start a Drop in Centre. The Regional Director stated that children were identified in order to be assisted with school uniforms, in Moshaweng 28 children and Gasegonyana 28 Children.

NGO funding

The Department is presently working hand in hand with Community Based Organisations (CBO’s), as there are no NGO’s in the North West part of the district. The department further noted that all CBO’s and projects have affiliated with CBO-network which was launched last year.

Challenges

• Shortage of staff
• Shortage of office accommodation
• High influx of applicants for disability grant.
• Foster care backlog
• No appointed Probation Officers for both Service Points. A social worker focuses on both generic work and probation work.
• A serious turnover of staff due to the fact that there is no retention strategy for people to stay in the area.

The committee enquired what the number of people applying for indemnity in the region is. The presenter stated that there were quite a lot of people applying for indemnity, but she was unable to give the exact figures of how many applied.

• The food parcel distribution was a challenge for the district, but they had local committees to monitor the whole process. On the issue of the decrease in the number of food parcels the district stated that this was due to a decrease in the budget.
• With regard to facilities at pay points e.g. shelter and chairs, a tender was awarded to a company where the department ensured that local contractors were appointed to deliver the services. At pay points the department makes provision for people in need of wheelchairs.
• The department stated that there is a shortage in foster care due to the shortage of social workers and a submission has been made to the province to fill these positions.

• That the shortage of social workers be addresses in the region.

The Regional Director began his presentation with the pay point development in the region. He stated that there are 51 pay points in the region and that one pay point have been developed and that 12 pay points need upgrading and that another 11 existing structures needs to be upgraded.

He further mentioned the challenges w.r.t. social security in the region:

• The high demand for disability grants due to the high unemployment rate within the region
• Resources are limited
• Problems with CPS machines at shops where they (shopkeepers) provide loans and the beneficiaries remain in debt
• The rise in disability grants is because of the rise in HIV/AIDS cases
• There is a big demand for food parcels as a result of unemployment
• The abuse of social grants

The department noted that there 118 cases of HIV and AIDS in the region. A number of 435 Care Givers received a stipend of R500.00 per month and 372 food parcels were distributed to child headed households and the social relief program also supports them. The Department has also given burial assistance to 41 HIV and AIDS to families from April – June 2005.

The number of caseloads handled by social workers increased from 117 242 cases and the children’s court is booked up to November for foster care placements. The NGO’s have a serious shortage of social workers and there is in nearly every NGO a social work post vacant and then it becomes the responsibility of the department to render in this vacant area a service. Another challenge is the shortage of vehicles for social workers to render an effective service.

Social Assistance Grants

The presenter stated that the total amount of beneficiaries in the region are 52 572 people who are receiving grants.

Food Parcels

With regard to the Food security parcels the region distributed 1850 food parcels. The target group for these food parcels are: orphans and young children, youth, people living with HIV and AIDS, vulnerable families infected and affected by HIV and AIDS, women and people with an income of less than R200 per month

Child Headed Households

In the region there are 114 child headed households. The department is assisting families and child headed households to access birth certificates and grants. The department is also trying to link and place children/youth in mainstream schooling. Youth are placed in the Adolescent Development Program (ADP) to restore self worth and self-esteem and parenting education to teenagers heading households. The department will also assist in the establishment of a community food garden in order to teach subsistence farming to young people and families.

In the Frances Baard region there 81 children awaiting trials- 39 Molehe Mampe Secure Care Centre and 42 Lorato Place of Safety and there are 9 children in prison

NGO funding and services

The Frances Baard region has twenty (20) NGO’s with a monthly funding of R16 822.00 and R2 018 688.00 annually. The presenter stated that the department relies mainly on Non-Profit Organisations to render specialized services, which include, substance abuse, services to people with disabilities etc.

In the Frances Baard region there are 46 Child and family organizations, 27 Homes for Older person’s, 6 Children’s Homes, 179 ECD Centres, 1 shelter for children on the street, 5 Protective workshops, 3 residential facilities for people with disabilities and 21 Service centers for the Elderly and disabled.

• The presenter stated that the abuse of grants is a major problem in the region and that the region does not have a specific unit that deals with this abuse and that the need is there for a dedicated team to deal with this issue. There are volunteers in the region to assist the Social Workers, with their already huge caseloads.
• With regard to burials of people who cannot afford it the department stated that, the department stated that they try to assist where there really is a need. The department makes provision for this in the conditional grant for burials, which are HIV and AIDS related, but it is a dilemma. The presenter stated that the municipalities are supposed to budget for this service. The department further noted that they are educating and encouraging people to take out burial policies.
• The presenter stated that the region is trying its very best to cope with foster care in the region and they are only able to do as much. The department spends a lot of time on each individual case before it goes to court. The department stated that they have an excellent relationship with the Department of Justice and that they also have a Child Forum, where they meet to discuss problems and bottlenecks with the Department of Justice.
• On the issue of orphans the presenter stated that the department is trying to speed up the process and that there are volunteers workers who assists the department well, with the result that the social worker only do investigations. The aim of this is to place the child as soon as possible.
• With regard to people living with HIV and AIDS the presenter stated that the region has done data research on e.g. what is needed to assist those living with HIV and AIDS. The aim is also to speed up assisting people who are terminally ill.
• The presenter stated that the physical infrastructure at pay points needs minor attention e.g. fixing toilets, tiling etc. If there are any developments to take place at these pay points the department involve CPS and the local municipality and the department has a healthy relationship with municipalities. The presenter also informed the committee that pay outs at the various pay points only happens till 14h00 and if payments are done after 15h00 the department has a Service Level Agreement with the Service Provider to provide the beneficiaries with food.
• The presenter stated that the CPS machines in the shops, the last option is to remove it from the shop and he further noted that it is the people themselves who abuse the system and at the end of the day it will be department who is responsible. The HOD stated that another problem is that the shop owners themselves abuse the system by hiking the prices in their shops and they also keep the smart cards of beneficiaries.
• With regard to Probation Services in the region the department has what they call the Home based Provision Programme, which is only in the Frances Baard district and they are planning of rolling it out to other regions. The children are trained in life skills to assist them and to keep them busy while they are waiting to go to court. The monitoring is done by the Assistant Probation Officers and they also have people assisting them. The presenter stated that this programme started as a pilot but now the region cannot do without it and they are becoming indispensable.
• On the issue of food parcel distribution the department look at various factors e.g the number of people in a household (and number employed in this household) etc., and this is when the department intervenes. The presenter stated that the department is making a concerted effort to assist the needy, the poor and the vulnerable in the region.
• The presenter stated that the department tries their best to rid the department of corruption, where they for e.g. beneficiaries cannot write, they take the thumbprint of the beneficiary and they make sure structures are in place to minimize corruption.
• With regard to the amnesty process in the region, the presenter stated that the process is ongoing.
• The presenter stated that the department is moving away from Old Age Homes and they make sure that they are Multi- Purpose Centres.
• The presenter stated that more needs to done to assist NGO’s in the region and the issue of subsidies to NGO’s need to be addressed as well.
• The department stated that there is a relationship with the religious organizations in the region, but these relations must be further strengthened and improved. Many of the soup kitchens in the region are run by Faith Based Organisations and without the department are really lost, as stated by the presenter.

• That the department has to minimize the abuse of grants and that they will have to develop a strategy to deal with this abuse of the system.

• The SC on Social Services stated that they would address the burial assistance to the poor with the National Department.

• To speed up the process of Foster Care in the region. That they have to liaise with the Department of Justice to alleviate the situation.
• The provincial department must get the assistance of the National department w.r.t. the establishment of NGO’s in the region. They must strengthen the relationship with the Faith Based Organizations.

The center was initiated in May 2002 and registered as a NPO in 2004. The objective of the center is the provision of a comprehensive 24 hour service for vulnerable groups which include, children, woman and men in the community.

The core functions of the center include:

• Children on streets
• Soup kitchen- the presenter stated that they also provide food to older persons if they are sick and the previous month (July) they had a number of 307 people whom they were feeding and these include unemployed people.
• Home based schooling- the emphasis is on the street children and the center teach them on how to deal with various problems
• Drop-in Centre- they applied for funding
• Trauma Centre – to use it for counseling purposes, because the police refer people to the center, but no response from the Department of Health
• Aged
• Shelter and other services

The presenter stated that the center receives little assistance from the Department of Health.

The Challenges of the center include:

• Resource allocation – the presenter stated that at one stage the center had 10 administrative ladies assisting them, but people leave because they do not receive any salary/stipend. There are no money to deliver services to the older person’s
• Sustainable income sources
• Additional and sustainable volunteer basis
• Medical practitioners and forensic services
• Strong broad based partnerships
• Little assistance from the Department of Health
• Repair of essential infrastructure and equipment (electricity, washing machines, stoves, windows and burglar bars)
• Upgrading and renovation (paint, flooring, clean up)

Commitments from the Department of Social Services and Population Development include: the funding for 2 development workers and 1 coordinator. The department also envisages funding in the current financial year for a list of needs as indicated by the center.

The HOD stated that the department of Social Development is responsible for the running costs of the center.

The presenter stated that Spoornet owns the building, which the center is occupying and the number of children at the center is receiving no funding.

• The Committee emphasized that the Department of Health will have to come on board and assist with the center.
• The Committee went on a tour through the center and found that the kitchen, stoves etc are in bad condition and that the department will have to link with other stakeholders to better the situation.
• Because the building is old many repairs will have to be done e.g painting, broken windows etc.

The Select Committee on Social Services visited the Resthaven Old Age Home on Friday 12 August 2005.

The presenter stated that Resthaven has been identified as a pilot project for a multi-purpose center to initiate a comprehensive One Stop service center for older persons. The new facility will host a basket of services e.g. service center, frail care, day care, transport and laundry services, meals on wheels, information center, health and beauty, etc.

The facility has bed occupancy for 48 residents and there are currently 25 frail and 23 independent residents who are taken care of. The facility is in receipt of a monthly subsidy of R48 487.60 from the Department of Social Services and Population Development.

The management board comprises of 10 members and meetings are held on a monthly basis. The management committee consists of volunteers who are elected every two years. Monitoring and evaluation is the responsibility of the Department of Social services and Population Development.

Funding has been allocated for the following:

• A 25 seater bus of R485 000
• office equipment of R340 00
• renovation of the home and the construction of a 200-seater hall to the amount of R2 million.

This forms part of the transformation of services to the elderly and people with disabilities to provide infrastructure for the implementation of community based services.

The challenges of the home include:

• Implementation of proposed organogram i.e. Sub-directorate for Special Needs
• Promotion of community involvement
• Strengthening of partnerships, interdepartmental as well as the private sector
• Research on needs of older persons in communities
• Training for management and staff
• Awareness campaigns in communities
• The frequent change of committee members affects the organization negatively, with the result the organization is continuously confronted with labour relations issues.

The Committee enquired from the one sister who works at the center and she informed the Committee that the following are some of the challenges faced by the center:

• That the infrastructure of the center was not created for an Old Age Home and that the center was originally build as a center for the abused and neglected.
• In the center currently there are more frail patients.
• She noted that the current staff members needs extensive training to deal with frail patients, because there is a strain on the current professional nurses
• The center needs a slues room, because currently they are improvising
• The center needs a sick bay

• Liaison with the department of Public Works in order to address infrastructure challenges
• They must revisit the staff establishment of the facility
• Budget allocation will have to be reviewed

The presenter the types of intervention by the center include:

• prevention, which includes outreach programmes
• early intervention services
• sport and recreational programmes
• educational programmes etc.

Challenges of the center include:

• infrastructural challenges
• the budget allocation
• lack of computerized tracking system to link with continuum of care services
• Recidivism of young people

• Members enquired whether submissions have been made regarding the budget. The presenter stated that the Senior Management of the Department of Social Services is making allocations and that the center will have overspending and the issue is being addressed.
• The presenter stated that the overcrowding is "artificial". He stated that the center is seasonal overcrowded, i.e. over the Christmas and Easter season.
• The presenter stated that the some of the dormitories are vandalized and that the Department of Public Works will be coming the following week to do maintenance work on the buildings.

• that the Strategic Plan of the center must include the budget as well
• that partnerships will have to be formed with other various departments e.g. Public Works

• The committee observed that the dormitories differ in size e.g. 1 bed, 2 beds, 4 beds
• Some of the dormitories are vandalized.There are 10 dormitories and 6 are vandalized
• There are telephones available for the children to phone their family members
• There is a woodwork workshop, which belongs to the provincial Department of Education, where the children can do e.g. welding etc.
• The center also supply the boys with clothes
• In the laundry the machines are old but still in a working condition. The sewing machine is broken down.
• The boys receive breakfast at 7am, lunch at 1pm, supper at 5pm and a snack at 8pm.
• In the principals office there is screens from where the principle can monitor the movement of the boys.

7. De Aar Clinic

The Committee visited the clinic on 08 August 2005.

• The presenter stated that PMTCT is a pilot project at the clinic
• The members noticed a waiting room and this is where patients get the date and time for their appointments. On the day of the visit the waiting room was not packed and the presenter stated that it is seldom packed and that there is no long queues and waiting time at the clinic.
• There is a administration office which is occupied by sisters, since there are no administration staff.
• No TOP is performed at the clinic, and this service is referred to Kimberley
• The presenter stated that they see about 120 – 180 patients per week
• The consultation rooms is open from 07:30 – 16:00
• The presenter stated that the equipment of the clinic is satisfactory, but that they are acquiring more.
• The clinic performs general Primary Health Care
• Doctors visit the clinic 2 times a week
• Number of staff at the clinic: 1 professional nurse, 1 nurse and 3 councilors

The MEC stated that the province has increased its number of ARV sites from 5 to 9 and they hope to increase this number. The department envisage to accredit other sites and to also strengthen other sites.

The province is in the process of training caregivers where they earn a stipend of R500.00 and after completion they will receive a stipend of R1000.00.

The MEC stated that the conditional grant of the department is currently R48 million.

The HOD stated that w.r.t. Prevention of Mother-to-Child Transmission (PMTCT) the antenatal clients undergoing HIV testing for 2004/05 was 79% and for 2005/06 70%. With regard to Voluntary Testing and Counseling (VCT) the numbers for 2004/05 was 71% and for 2005/06 87% attending clinics. He further noted that the Northern Cape has the second lowest HIV prevalence by province among antenatal clinic attendees in the country. The HOD stated that according to statistics the Tuberculosis incidence in the Northern Cape is 361/100,000 people in 2003.

Comprehensive Plan

The HOD stated that the department envisages a comprehensive service at every consultation and that it should be integrated with routine services provided for by the department. This can be done if the whole health system is strengthened. VCT services will be broad based as well. This will lead to a quality service, as stated by the HOD.

Community Health Workers

There are currently 1009 Community Health Workers in the province and these health workers, as stated by the HOD, must be trained on this comprehensive service. A 59-day training will commence in August 2005 and an accredited service provider is doing this and the curriculum is nationally approved. The HOD said that there is limited support for orphans and vulnerable children, but the department is doing what they can for these children e.g. provision of nurses, diapers etc, but the department’s involvement is limited.

With regard to the ART programme, the HOD stated, that there are 5200 patients who have been assessed (registered) and 2400 if these are not requiring ART yet, and 2800 requires ART and of those requiring ART 1600 are on preparation and 1200 on treatment. The HOD stated that a major challenge is to get doctors and nurses to the rural areas to be able to increase the number of sites and another challenge is the transport, because of the vastness of the province.

Strategic Priorities

The HOD stated that the strategic priorities of the department include:

• Awareness and prevention – to prevent people, who are HIV negative, promote the health of people living with the virus etc.
• Care and support – to implement effective community and home based care as part of the comprehensive plan, supporting compliance for life for those on treatment
• Treatment – providing appropriate, evidence based ART and manage the implementation of care package in a responsible, accountable, transparent manner
• Human rights – to respect the privacy and confidentiality of the clients and integrated HIV and Aids care through the Employee Assistance Programme
• Monitoring and Evaluation, Research and Surveillance – to provide appropriate, evidence based information for action and to monitor quality and evaluate performance through standardized annual surveys and strategic academic partnerships.

Health Infrastructure

The HOD stated that the Hospital Revitalization Programme is making good momentum. Two level 1 facilities, in Colesburg and Calvinia, have been completed and current revitalization Projects include: Specialist Mental Health Facility (R250m), Barkley-West Hospital (R40m), Upington Hospital (R230m) and De Aar Hospital (R200m).

The HOD further stated that are a number of new projects are under way in the province.

• Members raised concern regarding the retention of staff in the Northern Cape. The HOD stated that it is difficult to retain professional staff because of the migration to other provinces. He stated that for e.g. the Northern Cape (NC) were to increase the salary of professionals other provinces (e.g. Gauteng) would increase that of the Northern Cape, with the result that the Northern Cape can not compete with the other provinces. He noted that the department has to look at other incentives, e.g. looking at the environment people are working in, i.o.w. look at "softer" issues.

• On the question of whether there are clinics that offer 24 hrs services, the HOD stated that there are none thus far and that it has never been implemented. The reason for this is the shortage of personnel.
• With regard to security at hospitals and clinics the departments expenditure is R18m a year. The Committee expressed that they will take up the issue regarding security at clinics with the National Department of Health.
• With regard to the Infection Register the department stated that they do have these register at the hospitals and clinics. The HOD noted that specimens are taken quarterly and nurses are trained for this purpose. Kimberley Hospital has a unit dedicated in dealing with the infections at the hospital.
• Members raised concern regarding the number of ambulances in the province. The HOD noted that 30 new ambulances have been bought which are fully equipped and personnel have been trained as well. The HOD stated that a further 55 new ambulances will be received by the province, which will include 8 4x4’s.
• The HOD further stated that because of the vastness of the Northern Cape it is envisaged that the department make use of helicopters to fly patients to hospitals, for this will be much cheaper than what is currently operational, where these long distances are being driven.

• That the department looks at implementing clinics on a 24hrs basis.
• That the Department makes a study on the feasibility of utilizing helicopters in the Northern Cape.

All Primary Health Care (PHC) Facilities are run 8 hours a day, five days a week and negotiations are in place to extend the clinic hours.

The VCT uptake in the region for the last 3 months is: 1081 pre-test counseled, 1036 tested and 358 were positive (34,56%) and 293 (27%) were self referred.

The TB cure rate for the 1^st quarter 2004 was 54.16% and the treatment completion rate 13.88%, the failure rate 1.38% and the transfer out rate 8.32%.

With regard to PMTCT in the 1^st quarter of 2005 the antenatal (ANC) first visits was 333, HIV tests done on ANC clients was 178 (53%), ANC clients HIV positive 41 (23%), Nevirapene dose to ANC positive 30 (73%) and life birth to women who are HIV positive 23.

Termination of Pregnancy

The presenter said there is only one professional nurse trained in TOP in the region and no TOP is done at present to a lack of infrastructure and TOP is currently referred to Kimberley.

NGO sector

• Aganang – This is a Home Based Care and health Education group and 28 trained volunteers are assisting
• AnCRA – this is a land rights organization and their operational area is the Kgalagadi district (cross boundary)
• Aids foundation (funding for stipends) – they fund Dingleton and Van Zylsrus CHBC

Challenges

The presenter stated that the challenges include:

• Infrastructure
• Office space
• Transport
• Emergency Medical Services ambulances and trained personnel
• The effect of HIV and AIDS on Health services
• Lack of equipment
• Budget and Expenditure
• Shortage of logistics
• Governance and Community participation
• Implementing normal deliveries at all PHC’s

Kuruman Hospital

The presenter also gave a brief overview of the Kuruman Hospital. She stated that there are 64 beds in total and occupancy rate of 98%. Ward A is the maternity and surgical; Ward B is medical and surgical and there is a casualty ward and an Infection Control Room. Also at the hospital is a operating theater, Radiology department and a pharmacy.

The HR of the hospital are as follows: Hospital Manager (vacant), Chief Medical Officer (1), Permanent doctors (3), Community doctors (4), Pharmacist permanent (1), Pharmacist community (2)

All doctors do Primary Health care on a weekly basis.

• The presenter stated that there is no staff interested to be trained in TOP and the regional department has tried to motivate people to go for the training.
• There is 1 ambulance serving Van Zylsrus (110km gravel road) and 1 ambulance for Dingelton and 2 for Kuruman. There are 2 paramedics to assist in severe accidents, but 2 more are still in training. The presenter stated that Kimberley said that they will supply more ambulances, but the region is still waiting.
• There are no Primary Health Care Facilities, which operate 24 hrs, and there is no security at the clinics only at the hospital. The presenter stated that the district is looking at extending the working hours, but they need the infrastructure to do so. E.g. Dingleton has the infrastructure to do so, because they have 3 professional nurses at the clinic.
• The presenter stated that, with regard to infectious control, 2 staff members have been trained in July – 1 at PHC and the other at Kuruman Hospital.
• The Chairperson enquired regarding the infrastructure at the hospital and clinics. The presenter stated that the department looked at upgrading Kuruman Hospital, but they found that it was not going to adequate to do so. The district is in the process of upgrading the clinics.
• Mr Sulliman enquired what the conditions are like at the HIV and AIDS testing sites and Ms Lamoela enquired on hospital management and governance at hospitals. HIV and AIDS testing are done at PHC level and it is a normal visit and counseling is done as well. With regard to hospital management and governance she further stated that that there are measures in place for community participation, but currently there are no community committees as yet, but there is a health forum in which the department partake.
• With regard to Human Resources posts have been advertised and Kimberley has done the short listing. The presenter stated that what is needed for these professionals are accommodation and the rural allowance. The presenter further noted that the province is busy looking at a retention strategy.
• Ms Vilakazi enquired with regard to the kilometers traveled to clinics. The presenter stated that the only mode of transport for patients to clinics is public transport (taxis) and they are expensive for somebody who cannot afford it. The presenter also stated that the province have patient transport if the patient is referred from the PHC then transport will be available.
• A major problem in the district is that of private doctors where the patients from these doctors stay in the public hospital, and the doctor receives his money from this patient while he/she is staying in the public hospital. There was resistance from the private doctors when the provincial department stopped this "practice".

• The region have take up the situation regarding the availability of ambulances with the provincial Department of Health

• That the TOP service is to an important service and this service has to be available in the region and that the Department of Health make a concerted effort to rectify the situation.

• The operation of clinics 24hrs a day have to be looked at
• The region have to look at a strategy to attract and retain personnel

Primary Health Care Facilities

There are 23 facilities in the district providing comprehensive PHC services including maternity services. 2 facilities are open 24 hours 7 days a week and 4 facilities render 12 hrs 7 days a week service and 21 facilities render 8hrs 5 days a week services.

The cure rate of TB in the region is 71%. All clinics provide VCT.

Management and quality of services

The Regional Director informed the Committee that the clinical and admin management team is in place. Programme Managers are at Assistant Director level. Facility managers are in place for clinical supervision. Quality Assurance structures are in place in the hospital and patients and staff satisfaction surveys are being done. A Batho Pele indaba was held in the sub district where the community participated and where the community was encouraged to critique the department. The department is also looking at various complaints mechanisms.

Human Resources

Human Resources for the district are: approved 289, filled 216 and vacant 73.

Governance

The regional Director stated that six Governance structures were de-established on the 3^rd of September 2004.

Finances of hospital

• The hospital/PHC management is delegated to authorize purchases up to R50 000 and items on tender/contract no limitation.
• Authority up to R100 000 with district Bid committee
• Minor maintenance budget with hospitals

The PHC services for 2004/05 expenditure were R30m and the allocation for 2005/06 is R42m. For hospital services the expenditure for 2004/05 was R42, 6m and the allocation for 2005/06 is R35m, but the regional director stated that it will be around R45m.

Termination of Pregnancy

Patients receive appropriate counseling from trained staff. This service is available on request at the hospital and PHC services. An average of 21 CTOP per quarter are performed.

Challenges

• The physical structure of the hospital
• The attraction and retention of skilled personnel and cross boundary of professional nurses
• Slow progress of capital projects
• Equipment for upgraded clinics
• Emergency Medical Services (EMS) have only two vehicles
• The road infrastructure are not good for the life span of the vehicles
• Vehicle Replacement Plan
• Accommodation for nurses is a major problem
• Maintenance of buildings

• Ms Lamoela asked whether the district has a strategy to retain and/or attract skilled staff and also enquired regarding the issue of infections. The presenter stated that the issue regarding the retention and attraction of professionals is three fold:

• those doctors who are doing community service, if they are medical officers, to for e.g. promote them to Chief Medical Officer.
• Training all professional nurses to dispense
• Improving the accommodation and providing basic furniture to professionals.

• On the question of how CBO’s are monitored the presenter stated that these organizations are required to submit evidence on how they spent the money given to them by the Provincial Department of Health.
• With regard to infection control mechanisms in the clinics the presenter informed the committee that all institutions have policies and standards in place and last quarter no infections were detected, despite the poor infrastructure at some of these institutions.
• The Executive Mayor stated that the district was promised 2-roomed clinics, but nothing was delivered, even she tried to intervene, but still nothing. The department stated that the 2-roomed clinics would come in the 2006/07 financial year.
• With regard to the revitalization program the presenter stated that he is not able to say where the new hospital is going to be build, but that the funding has been approved and that they (provincial department) only have to decide where to build the hospital.

• The region has to look at a strategy to attract and retain personnel.
• The issue of the 2-roomed structures will have to be followed-up with the provincial department of Health.

• That the department takes up the issue of the hospital boards.

Management and quality of services

Six (6) PHC clinics in the Sol Plaatje render a full package of PHC, and 2 are due after training is to commence in ANC (antenatal) services. Four clinics have been identified to provide 24-hour service and staffing plans are underway. A new clinic is also going to be build in Barkley-West. Clinic supervisors are to be appointed to enhance quality management. Other clinics will be also providing health services beyond 18 hours. One community health center provides 24-hour maternity services for the population of Sol Plaatje Municipality.

Human Resources

The presenter gave a breakdown of each of the 3 municipalities, regarding its Human Resources and it was clear to the Committee that there is a shortage of staff in the region.

Facility Infrastructure

The representative of the department noted that most clinics "can do" with revitalization.

Termination of Pregnancy (TOP)

The Regional Director stated that the service is provided at the Galeshewe Day Hospital (CHC). The presenter stated that from February 2005 to July 2005 an average of 246 people per month requested TOP. It was stated that persons who are over 12 weeks pregnant are referred to Kimberley Hospital.

Challenges

• Unsuitable PHC facilities where buildings are too small to handle the daily patient load
• The cross boundary issues at Hartswater and Jan Kempdorp, where 60% of PHC clients at clinics are from the North West Province. The presenter informed the Committee that previously the North West (NW) gave one nurse, and her salary was paid by the NW and in July the NW took her back and now the Northern Cape wants to continue with the agreement as it was before July.
• Functional integration – challenges of dual management: confusing and conflicting messages.
• Insufficient vehicle allocation to PHC services and shortage of mobile units to render PHC services in some grey areas.
• Inadequate and inefficient patient transport management especially in the Vaalharts area. The presenter stated that the budget for vehicles must be addressed.
• The poor community participation, where very few facilities have functional clinic committees. They must begin to start setting up hospital boards.
• Recruitment and retention of professional nurses for rural areas. The presenter stated that the scarce skills allowance that the staff receives is taxed, with the result that they receive very little after it has been taxed.
• Platfontein is a challenge – the department tried to put 2 youngsters through nursing from Platfontein, but the whole experience was a "cultural shock" for the 2 of them, and they did not finish the course.
• Clinics are not getting empty, but the department is busy with health promotions.

• With regard to TOP the department stated that they had 2 nurses performing TOP, but not anymore. The nurses did not want to perform this service any longer and one of the reasons was that they had to perform this service to young girl about 3 times. The presenter stated that provision is made for pre-counseling before the training begins.
• On the question the relationship between the department and traditional leaders in the region the department stated that they had a summit in July where it was envisaged that the department and the traditional leaders be brought together and that this is still an ongoing process. He further noted that the traditional leaders are involved in STI’s, TB etc.
• The presenter stated that TB is a major problem in the region. One of the factors contributing to this is the fact that many of these patients are seasonal workers who contract TB, the clinic treats them and after this they disappear. The department stated that they have had talks with farmers to assist the department and this is ongoing.
• The issue on the 2-roomed structures the department stated that the Northern Cape has containers as clinics, which is serviced by mobile clinics, and in the region there 2. The department would want to have more, but the budget is not sufficient.
• With regard to the hospital boards, the department stated that in July they had discussions with politicians in the region to assist the department with nominations of people to sit on these boards and it was advertised as well and they also hoped that it would cascade down to clinic committees as well.

• That the TOP service is to an important service and this service has to be available in the region and that the Department of Health make a concerted effort to rectify the situation.
• That the relationship with the traditional leaders be strengthened.
• That the region develops a strategy to deal with patients not doing the full cycle of the TB programme.
• The department take up the issue of the Hospital boards

The Select Committee on Social Services visited Galeshewe Day Clinic on 11 August 2005. The Management of the Clinic took the Committee on a tour of the clinic.

• In the foyer of the clinic the committee noticed that there was suggestion box
• At the entrance was a registration section, which indicated to patients which they should go
• Management stated that the Provincial Department of Health is busy revamping the clinic
• Management informed the committee that there are no fax facilities at the clinic, and if they wanted to fax documents they had to go Kimberley Hospital to do so.
• One of the major problems at the hospital is the shortage of staff
• The post of manager at the clinic is advertised and they hope to fill he position soon
• Maternity section

• There is a waiting room for family members
• In the 1^st stage there is 3 beds, labour ward 4 beds and post natal 9 beds
• There is a shortage of staff in this section
• In this section there are 2 nurses per shift, but the need is 3 sisters and there is one student midwife
• The section is operational 24hrs

• The TB room is confined
• Management stated that a ARV and ART site still had to be identified, and the 1^st ARV room that was identified was to small
• Termination of Pregnancy (TOP)

• There is 1 sister for performing TOP and she is trained and registered
• This sister is assisted by 2 students
• If the pregnancy is over 12 years the patient is referred to Kimberley Hospital
• In this section there are information on the wall

• The clinic has a pediatric department
• Information regarding breastfeeding is on the walls
• Management stated that there are 2 doctors: 1 every week and now and then 2 sometimes 3 per week
• Dispensary

• The supply of medicines are not good with the result that there shortages
• There is only 1 fridge in the dispensary
• The storage room is opposite the dispensary
• There is one pharmacist
• 3 assistants assists the pharmacist

• The clinic has only phone, which is in the Clerk’s office. If the clinic wants to fax documents they have to go to Kimberley hospital.

• That the SC on Social Services will address the issue regarding the telephones and fax machines with the Department of Health.

The visit to the to the Manne Dipico Hospital was on the programme of the Committee, but the Committee decided to go and see the revitalization programme of the Department of Health, and the Committee did not regret visiting the hospital, even though it was out of their way.

Manne Dipico Hospital is a 45-bed hospital situated at the center of Colesburg. It is a center of best practice with multi-skilled staff, multi skilled in the sense of being able to render all the services that are being rendered by a level 1 hospital 24hrs around the clock.

All the registered nurses are primary health care trained so that when they are on duty sorting assessment of clients at the casualty department is done by a clinical nurse practitioner.

The hospital is committed in preventing the spread of infectious diseases as well as fetal alcohol syndrome, which is a major challenge in the province.

The hospital render rehabilitative services from the very first day of patient admission till the discharge date by talking to the patients refer them to the relevant sources e.g. social worker, psychologist etc. Physiotherapy as well as occupational therapists is available at the hospital on a three weekly basis.

There is a pastor in the hospital who serves as a counselor, who is available 4hrs a day for 4 days in a week for spiritual as well as for counseling needs, even a female counselor if patients choose to be counseled by a female.

Forensic services are also rendered by the hospital. The forensic room is situated next to the casualty entrance so that patients who are molested maintain their privacy and dignity by not walking through long hospital corridors and seen by everybody. There is one forensic nurse available 24hrs, failing which the casualty nurse on duty will contact the relevant people for attention. Patients are seen in the forensic room examined and all the necessary tests are done there even the police statement is taken in the same room by police, patients are then given a chance to bath and they are given a consolation box with a panty, soap, washing rag, and a perfumed powder.

All patients are urged to go to the primary health care centre first before coming to the hospital with their problems. At the primary health care centre they are seen by a doctor if needs be and then be referred to the hospital. Patients who are by passing the clinics are going to be charged a fee and a casualty fee. If a patient comes in for X – rays be it private or public a X- ray form must be filled in properly by the referring doctor.

The management team of the hospital consists of:

• A hospital manager
• HR Manager
• Finance Manager
• Nursing Service Manager
• Medical Officer

An information corner is identified which will help people with any information they want about the hospital and the services rendered.

An overnight facility is available at the hospital to accommodate people who brought their families in hospital or for people who are involved in motor vehicle accidents as the area is a high accident zone because of the N1 road.

For the staff the hospital has a district psychiatry co-coordinator who is also excellent in rendering stress related counseling as well as physiotherapy. Alternatively the hospital manager is a trained trauma debriefer and she introduced an open door system for people who feel like talking to her. Once a month the staff get together for casual gathering, where staff there is a open floor for staff to talk about their problems, be it work related or other wise.

Tour of Manne Dipico Hospital

• This is a Level 1, 45 bed hospital (35 public and 10 beds of choice)
• In the high care center there are 7 beds and there is a trauma center and the manager informed the committee that the hospital is mercury free
• The rates of the hospital are calculated according the income of the patient
• The manager stated that if a patient is not critical he/she will be treated by the hospital, but if he/she is critical, he/she will be referred to either Kimberley or Bloemfontein
• The hospital has 5 ambulances, which are all fully equipped, because of the many accidents that occur on the N1 road.
• In 2005 the hospital was awarded the Premiers Service Excellence Award
• There is a staff room and a tea room
• The committee observed that the equipment of the hospital is well equipped and that the hospital is very clean
• One sister has undergone training in TOP in Kimberley and she is now busy with practical training
• The theatre is equipped with new equipment
• The committee also observed that suggestion boxes are visible through the entire hospital
• The nurses station is near to patients to tend to them
• The hospital is busy with the construction of a further 10 beds of choice
• In the burn unit there is one bed.
• In the laundry all the machines are in good working order
• The bodies in the mortuary are kept for 48hrs after which the family members have to pay. There are 18 shelves in the mortuary, all in working order.
• The autopsy room is also being utilized by SAPS

• That the Manne Dipico Hospital (Colesberg) be used as model by the Department of Health for their Revitalization programme across the country.

Background

Kimberley Hospital has rapidly grown from a level II facility to a level III facility rendering a variety of specialist services. With this expansion in service the demand on upgrading and expansion of physical infrastructure was inevitable. This has lead to various portions of the building being upgraded to meet the demands in space and physical work areas.

Recent infrastructure upgrading

• The main theater block was upgraded in 1999 in order to maximize activity flow and increase efficiencies in operations.

• In 2001 major upgrading was done to the main hospital building and included the following areas: front gate, main reception, pharmacy, main hospital passage, specialists clinics and the establishment of a hospital radio station.
• Soon after this private wards were constructed allowing all clinical disciplines to admit private patients and thus increase the opportunities for revenue generation.
• In 2003 three new lifts were installed in the older section of the hospital.
• Short stay ward was constructed in 2003 as part of the Accident and Emergency Unit.
• A sound booth for hearing testing was installed in 2004 as part of the speech therapy and Audiology unit.

• Radiology department was upgraded with the installation of a CT scan in 2003 and a MRI in 2005.
• Satellite pharmacy was built in 2004 to serve the specialist clinics.

• Expansion of the main theater block to 5 theaters.
• Establishment of a head and neck unit including the following services: ENT, Maxio-facial surgery, dentistry, Speech and Audiology.

• ENT upgrade
• Quality Assurance Offices
• Physiotherapy upgrade
• Occupational Therapy extension
• ICU Isolation and upgrade
• Neonatal I.C.U relocation / upgrade
• Signage
• Oncology / Congo fever unit / Pediatrics wards
• Pharmacy bulk store
• Consulting room air conditioner – private wards
• Resource center
• Casualty door / replacement
• Fire detection
• Satellite X-ray
• Kitchen upgrade
• Staff cafeteria
• Rehab Center upgrade
• Renal Unit relocation
• Transit station
• X-ray Department upgrade
• Records Department upgrade
• Visitors Waiting Area at front gate
• Establishment of Maxi-facial Unit
• Clinic engineering w/shop relocation
• Laundry sluice
• Mortuary cold room
• Flats for staff accommodation

Clinical Services

• Internal Medicine
• General Cardiology
• Dermatology
• Lipidology
• Clinical Immunology
• Clinical Haematology
• Intensive Care
• Burn Unit
• Colorectal Surgery
• General Surgery
• Hepato-biliary Surgery
• Vascular Surgery
• Ear/Nose/Throat (ENT)
• Ophthalmology
• Neurosurgery
• Maxilo/Facial Surgery
• Orthopaedics
• Plastic and Reconstructive Surgery
• Accident and Emergency (A & E)
• Neonatal ICU
• Medical Oncology
• Tertiary Oncology
• Nephrology (Renal Dialysis)
• Spinal Injury Management
• Paediatric
• Obstetric and Gynaecology
• Specialist Clinics
• Private Consultation
• Anaesthetics
• Complex Radiology (CT Scan and MRI)

Clinical Support Services

• Pharmaceutical
• Physiotherapy
• Occupational Therapy
• Speech Therapy
• Social Work
• Dietetics
• Orthotic & Prosthetic
• Psychology
• Radiology

Quality Assurance

• CSSD
• Compliance Service
• HIV/Aids
• Infection Control
• Occupational Health

Partnership

AMS (Red Cross) – Outreach Services

QUALITY ASSURANCE

The Quality Assurance Department was established in 2001 after a need was identified to improve service delivery at Kimberley Hospital Complex. The receiving of numerous wards including two Premiers’ Awards sees evidence of success. The activities of the department are as follows: -

COMPLAINTS PROCEDURE

Patients/clients or relatives are encouraged to "Tell us their views" by means of either a written/verbal complaint or compliment – enclosed is a "Tell us your views leaflet."

These are posted in Complaint Boxes, which are strategically placed in every department and are collected on a daily basis, sorted out and acknowledged within 7 days as per protocol. All the complaints/compliments are handled in line with the Complaints procedure – copy enclosed.

The complaints are a mechanism of the Institution to encourage criticism or compliments from the community. Batho Pele Principles and Patient’s Rights Charter are work shopped to patients and staff on a regular basis and are strategically placed in all the departments for everyone to see.

RADIO TALK SHOWS

Community involvement and development are imperative in this department and as a result radio talk shows are conducted twice weekly with two radio stations viz Radio KHC, which is institutional, and the National radio, which is Radio Motsweding. Experts on subject matter are deployed to deliberate on topics as per the National Health Care Calendar.

PROFESSIONAL DEVELOPMENT

On going in service training is carried out on Quality Assurance continuously and training needs as per gap identification is addressed by means of in-service training with close liaison with Human Resource Development.

QUALITY IMPROVEMENT

Each and every department has a Quality Improvement representative acting as a resource and policing quality care issues in their respective units. All these individuals are part of the Quality Improvement Team that is responsible for overseeing Quality Improvement in the Institution. Planned inspections and spot checks are done randomly in the Institution at regulated intervals.

OTHER ACTIVITIES

The other functions that are carried out are the following: -

• Clinical Audits
• Patient’s Satisfaction Surveys
• Process Mapping
• Staff Satisfaction Surveys

These are all carried out as a form of research to ensure that the department is still functioning in line with the expectations of the National Policy on Quality Assurance.

The Provincial Manager gave the Committee a short presentation on the Department of Home Affairs in the Northern Cape:

Introduction

The Northern Cape is the largest province, but it has the smallest population (984 327) of all 9 provinces in SA. The Northern Cape (NC) is divided into two sub regions namely Kimberley and Upington. The province has an approved establishment of 172.

ID Status

The presenter stated that with regard to the ID status, the number of ID’s collected are 14 432, uncollected ID’s 3 768 and the department, in the NC travels on average 65 267 km per month.

Distribution methods for uncollected ID’s

• Posting ID’s direct from Head Office(HO)
• Priority mailing from offices to clients
• Over the counter handing over of ID’s to applicants
• Door to door deliveries when mobiles re-visit areas e.g. Saturdays
• Stakeholder cooperation through availing distribution lists
• Maintaining database of cellphone numbers if available to introduce SMS to clients in August 2005

Birth on-line registration

This service is available at Kimberley Hospital, Kuruman Hospital, Central Karoo Hospital (De Aar), Gordonia Hospital (Upington) and Dr Van Niekerk Hospital (Springbok).

ID Campaign

The presenter stated that 5 mobile units were deployed within the province. The Department also has relationships with various Media sources in the NC, which include, newspapers, TV, radio etc. Stakeholder relationships include various political parties e.g. ANC, DA, UCDP, ACDP, FF, PAC etc., different organs of state (departments) and others e.g. farm unions, Nicro, SALGA, traditional authorities etc.

Flexi hours

The Provincial Manager stated that the province embarked on a project ensuring that the Home Affairs Offices become more accessible to the public through the extension of their operational hours. He noted that all offices in the NC will be open to members of the public from 07:30 until 15:30 and offices are also open on Saturdays from 08:00 until 13:00. These working hours are all done on a voluntary basis and no overtime is being paid.

Achievements include

• Five hospitals Online for Birth registration
• Counter corruption successfully – 7 officials suspended since April 2005
• 4 Multi Purpose Community Centers operational
• Upgrading of IT equipment

Challenges

• Managing flexi hours with limited staff
• The vast distances peculiar to the Northern Cape
• Huge vacuum in management, especially the Sub Region Kimberley (Deputy Director, Assistant Director, 3 Senior administrative Officers vacant in Kimberley)

Northern Cape Immigration Services

The Provincial Manager indicated to the Committee that the Northern Cape borders with two SADC countries namely Namibia and Botswana. The region consists of twelve Port Control offices. The region consists of five internal tracing units responsible for internal tracing, investigations, repatriation/deportations and prosecutions.

The Provincial Manager gave the Committee a breakdown of the operational background of the twelve Port Control Offices indicating where they are situated, their operating hours, traveler’s statistics (South Africans and foreigners).

• The Members raised concern regarding the deportation process. The provincial manager stated that the department does it directly, where they arrange with Botswana and Namibia. He further noted that if they deport to Zimbabwe, they take them to Lindela, from where they are deported. If the deportee is a Lesotho citizen they him/her to Bloemfontein, and from there to the Maseru Bridge, from where they take him/her to Lesotho.
• A concern of the Committee was the availability of mobile units, because of their vastness. The Provincial Manager stated that the mobile units were launched in June 2004 and Head Office did not award any to the Northern Cape. The provincial manager stated that the department wants to open a satellite office in Potmasburg and in Prieska, but the budget allocation is totally inadequate and they asked for R3m additional funds.
• Security is done centrally from Head Office and the department had problems Kimberley, but it has been solved.
• The presenter stated that photographs remain a problem in the rural areas and he further noted that the department procured cameras, but according to Treasury people still has to pay for their photographs.

• That the issue of the mobile units in the Northern Cape be raised and discussed with the Top Management of the Department of Home Affairs.
• The issue of photographs is taken up with the department.

The presenter informed the Committee on how the strategies that they use to distribute ID’s

• They advertise their visit in the local newspaper on a weekly basis
• They hold community meetings/imbizos
• Mobiles – door to door delivery of ID’s
• Submit a list of ID’s according to places to stakeholders

The state of unclaimed ID’s in the region are: Kudumane Rural Areas (North West) 506 ID’s and Kuruman (NC areas) 427 ID’s.

With regard to the quality of service delivery, the Regional Manager stated that a vigorous campaign is being launched to the rural areas regarding the Identity Document campaign. This include:

• Proactive approach is being implemented
• The involvement of various stakeholders
• The distribution of the list of unclaimed ID’s
• Opening of the satellite office in Postmasburg to serve the surrounding areas.

Human Resources

The office establishment personnel structure makes provision for a staff component of 17 officials. The office is having 2 teams for mobile units (2 officials per team).

Physical Infrastructure and equipment

The office vacated to a new building in 2004 with new furniture, new vehicles and equipment. Of the new vehicles received is 2 4x4’s, which will be used for mobile units because of the bad gravel road.

Information Technology

New PC’s replaced old PC’s. The office received 12 new PC’s and 8 printers.

Challenges

• The unavailable infrastructure for instance no accommodation, telephone and electricity, especially in the Kudumane region
• Places without water and toilets are not served
• Places served by Social Services for payment are not utilized by Home Affairs
• No camera films for the Lokisa Ditokomane Campaign
• Shortage of staff
• Shortage of UserID’s for the interns

• On the issue of the relationship between the departments of Social Services and Home Affairs, the presenter stated that in some cases the mother of the child is not in possession of a valid ID (mother is awaiting her ID) and the grandmother has one, the department of Social Services will assist. The relationship was previously that Social services accompany Home Affairs when they went out with the mobile units.
• The Regional Managers stated that there is sufficient security at the offices e.g. alarm system.
• The presenter further noted that the staff is made aware of the risks involved in fraud and corruption and they have regular meetings to discuss these issues.
• The office constantly monitors the time spent in the queues and all officials at the 4 points cover most of the services rendered by the department. In the office there is "floor workers" as well, who assists patrons to ascertain what services they require.

• That the relationship with the department of Social Services has to be strengthened again. That the Regional Manager and her counterpart in Social Services must begin talks and starts implementing strategies.
• With regard to the number of Ports of Entry, the Committee stated that it is up to them to make a proper study if necessary to determine whether this number of Ports of Entry is really needed.

The Regional Manager stated that the office is ideally situated in the CBD and close to a taxi rank. The office operates on a daily basis from 07h30 – 15h30 and on Saturdays from 08h00 to 13h00. The office opened a fixed service point in Galeshewe and this is a fully-fledged office.

The presenter informed the Committee on how fraud can occur and the prevention of fraud methods on the following: marriages, identity documents, passports, migration, and finance/face value.

With regard to risk management staff are rotated every year to curb officials manipulating the system to their advantage. Staff is continuously exposed to training. The applicant must collect the identity document personally and if not possible the applicant must give written permission that the bearer of the letter can collect the document.

The presenter stated that the office has currently 5 vacant posts and 6 posts of which the officials are on suspension. Two of the clerk posts are permanently placed at the Galeshewe Safety Center. She further noted that the remaining staff must be applauded as they are performing their duties and the vacant and suspended officials duties on a daily basis without complaint. The proposed office in Prieska is in the pipeline and the staff establishment was allocated, but the funding is still awaited.

Information Technology

• All the old mainframe computers were upgraded to new systems and a total of 13 systems were received.
• There is an IT technician that assists all the offices as far as Springbok. Previously the office had to contact Head Office and wait for a technician to be called out.
• Six officials in the office has access to e-mail facilities
• The department moved over to a new system regarding user ID’s and this is the logon system for every official open for the mainframe.

Challenges

• The suspensions of the officials places a heavy burden on the office
• The low staff morale after the arrests and subsequent suspensions
• No overtime is paid to officials

• With regard to the registration of births, the department stated that, because many of the people cannot give the names of the children in the hospital (where they have to consult with other family members) these mothers are given a return date to register and they pre-complete the form.
• On the issue of foreign marriages the presenter stated that they 1^st bring the couple to the immigration officer to conduct an information session and after this an intensive interview is held at the residence of the couple. Every year the immigration officer check to make sure that the couple is living together. If the Department is not happy with the situation the couple are de-registered. The presenter stated that the rate declined after the suspension of the officials.
• The presenter stated that 6 officials were suspended and more than 20 people were arrested. The marriages of those people involved were declared null and void. The presenter stated that Pakistani’s and Bangladeshi’s were mostly involved in these fraudulent marriages. There were under cover police at the office to collect evidence.

• Officials were bought from Upington to assist in Kimberley for 2 months. The presenter stated that during the winter the situation was worse when e.g. up to 9 people were off sick on a particular day. She further noted that the office had 5 Senior Administrative Officers and now has only 1 and the office is trying to get stability.
• The presenter stated that there is no compromising of user-id’s in the Kimberley District Offices. Officials in the Kimberley Office are rotated and multi-skilled.
• With regard to the mobile unit in Prieska, the Provincial Manager stated that a lot has been done and a memo has been sent 2 months ago and reminders have been sent as well.
• The Provincial Manager stated officials work voluntarily on Saturdays. The officials are rotated every week and at the counters they perform all functions.
• The Provincial Manager stated he is not assisted by e.g. a Deputy Director to manage the Northern Cape.

• That the issue of the mobile units be addressed with the Department of Home Affairs.
• That officials working overtime be raised and discussed with the department of Home Affairs.
• The issue of middle-managers be taken up with the department
• The issue of no assistance to the provincial director (Deputy Director)

WAY FORWARD

• The Committee will undertake follow-up visits to the province, in order to provide oversight and monitor progress made with regard to some of the challenges raised by stakeholders during the oversight visit.
• The Committee will take up some of the issues raised with the Department of Health, and will continue provide oversight on departmental strategic plans to ensure that the relevant issues are taken up in strategic and operational plans.

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