• 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.

The Committee has prioritized the provinces, which they wanted to visit during the 2005/06 financial year and the Committee identified the Free State Province as a priority.

This report aims and envisages that the challenges experienced by the various regions in the Free State Province are taken cognizance of and that are addressed to improve service delivery to our people. The Committee undertook this oversight visit to the Free State Province not to "police" the Provincial Departments of Social Development and Health and the Department of Home Affairs, but the aim is to "unblock the blockages" that might be hampering service delivery.

The information was gained by interacting with the MEC, HOD and Regional Managers of the Provincial Departments of Social Development and Health and the Department of Home Affairs. Before the oversight was undertaken the Committee identified the regions which they wanted to visit and the aim is to visit the rural areas, where service delivery is not up to standard (Batho Pele).

The Committee also takes tours of health centers; social development centers and Home Affairs offices to ascertain whether what has been said in the meeting with the various stakeholders are a true reflection.

Limitations of the report:

• The fact that not the whole of the Free State Province could be visited, but only parts of it
• The fact that the delegation could not visit for e.g. pay points on the day of payouts. It is the intention of the Committee to arrange for future visits to arrange this.

The delegation had meetings with the various MEC’s, HOD’s, Regional Managers and undertook tours of the institutions, which they visited. This report will highlight the important issues raised during these meetings.

1. VISITS TO DEPARTMENT OF HOME AFFAIRS REGIONAL OFFICES

1. BLOEMFONTEIN REGIONAL OFFICE

The Regional Manager informed the delegation that previously the ID’s could not be locked up because there was no strong room and the office has currently 2000 undelivered ID’s in the office. The Manager stated that since the beginning of September 2005 no ID’s was delivered, due to the 3-month period that is in place and after this period has expired the office will begin to deliver the ID’s. He further noted that ID’s is locked up and that the office does give ID’s to councilors to give to clients.

The Manager stated that they try to obtain the telephone numbers of the clients to inform them of their ID’s, but that this exercise is very costly and that the department is in the process to finalize the process of sending SMS’ to clients.

The manager informed the delegation that the office is making use of interns and that their contracts will be expiring soon (end of November 2005) as well and that the office has already lost 12 people and places a heavy burden on the remaining staff to deliver an excellent service. With regard to the 12 people the manager stated that some are under investigation and that 3 have returned and some were either dismissed or suspended.

The office is servicing 17 towns.

The manager stated that there are 3 people working on the mobiles and they only go out twice a week and they work out of any space that is available and that they are "at the mercy of the local municipality" and that conditions under which these people at times work is not conducive, but that they perform their duty.

With regard to the infrastructure, the manager stated that it is better than what it was previously. A problem at the current offices is the escalators and that at times people have fallen and broken their legs. There is security at the front to assist people, but at times it is difficult for disabled persons to enter e.g. person in wheelchair. There is also no parking at the offices, and the manager stated that their contract expires in 2006.

The manager stated that the deliveries of ID’s in not as successful as they would want it to be e.g. many give the wrong addresses and this delays the process.

The manager noted that there is not sufficient personnel dedicated to do registration of births at the hospitals.

With regard to fraudulent marriages, 6 fraudulent marriages are under investigation, but the response from Head Office is very slow.

With regard to IT, the computer systems has improved and the office has received a number of new computers, but that they are still working on old passwords and when the passwords expires it takes time. The manager stated that the printers on the new system do not work well and that the back-up system is problematic.

The manager informed the delegation that the new fingerprints system is going to be installed in December 2005.

The office is basically implementing the objectives of the fraud prevention plan that was compiled for the whole province, the dynamics thereof being:

• Ensuring that cash received is banked daily, that cash registers are programmed in such a way that only one transaction can validate per transaction.
• The daily intake or transactions are controlled and checked by supervisors daily and also weekly by the officer in charge.
• Two officers do banking i.e. one official cannot do banking without being accompanied by a witness, thus ensuring that it is not easy for one to collude with the bank official.
• There are no security guards; this is one risk area that the office finds itself in, as there is no proper access control of people entering the office. However, alarm systems have been installed in the office to ensure safety of government assets.
• The office is receiving a reasonable number of identity documents. Currently the total number of uncollected Id documents in the office is 325. The collection process is very slow and even if posted to given addresses, about 80 % of them end up being sent back undelivered due to wrong address.

• The office has implemented several means of trying to deliver the Id’s of which amongst others is door-to-door delivery, posting to serviceable address, listing Id’s and handing it to the councilors to inform people in their constituencies to collect Id’s at the office.
• It has however been noticed that the method of posting seems to be an easy one, whereby Id’s are delivered in big numbers, has proved to be risky as there is no proper and definite confirmation of control whether the rightful applicant is the one who received the document. The postman only put the Id’s in a postbox at the given address without positively identity of the applicant. Sometimes where there is no post box identity documents are just thrown into the yard and this therefore contributes to the risk of identity documents ending in the wrong hands and thus causing the level of fraud to rise.
• Other risks that are growing and seem uncontrolled is the increasing number of Late registration cases over 15 years, whereby people freely and fraudulently acquire baptismal certificates and other proofs, clearly being illegal foreigners. They then apply for identity document later is able to access different forms of services and grants offered by the government.

Quality of service has somewhat improved at Thaba-Nchu service point to a certain degree especially with the appointment of the interns.

In order to enhance service delivery extended working hours during the week have been implemented, namely 07:00-17:00 when officers work flexi hours. Offices are also open on Saturdays from 08:00-13:00.

• The current accommodation is not user-friendly as there is not enough space inside i.e. office is too small and allows only a limited number of people to get inside.
• There are no air conditioners, therefore during hot summer days and high temperatures serious health problems are caused
• Alarm systems have been installed in the office to enhance safety and security, however; lack of physical security in the form of security guards still leaves serious risks.
• Recently in 2004 the department has entered into a five (5) year lease agreement contract with the owner of the building, however it is envisaged to move to a bigger office once the contract expires. There is also no fridge, microwave or stove.

New computer systems with updated programs like GroupWise etc have replaced Five (5) old terminal computers in the office. Additional Computers are needed to allow smooth running of services e.g. scanner for passport, computer for E-mails and administrative functions.

Only one (1) printer is allocated to this office to print Births/Deaths Marriages Temporary Identification certificates. However, this causes delays, as people have to wait for one to get finish with a particular transaction before the next transaction can be started.

The office cannot scan passports, as it has to borrow the scanner to other offices in the Province i.e. Sasolburg service point and this results in that passport applications are delayed.

User-id’s of this service point have often been used to capture fraudulent transactions, e.g. fraudulent marriages. In all the cases reported, these marriages were captured in other Provinces or towns e.g. Durban, Cape Town, Johannesburg and Pretoria.

A request has since been sent to head office to block them but still there are people out there who still continue with the practice.

The Provincial Manager stated that overtime is paid out of the Provincial budget savings (i.e. vacant posts.)

It was also clarified to the delegation that ID’s couldn’t be produced locally as only Head Office has access to HANIS system.

It was also put to the delegation that the turn around time for applications is restricted to one day in the offices, however, there are constraints to this due to human resource capacity.

It was also made known to the committee that the department has embarked on a stakeholder forum with other government departments, e.g. Social Development, Correctional Services, SAPS, NGO’s and Education, to ensure that all services can be accessed at one point.

Information sessions are constantly held to inform the public about the services of DHA, also with chiefs/councillors and church leaders/Ministers to fight corruption of illegal issuance of fraudulent documents.

• Among the challenges facing the office is to capacitate the office in terms of Human Resource in order to live up to the Department’s vision of rendering a world-class service.
• To computerize Dr.J.S.Moroka Hospital in Thaba-Nchu to allow online-registration of newly born babies at Hospital.
• Acquisition of the necessary funds/budget as requested by the province. Filling of all vacant posts in the Province and the Acting Provincial Manager alluded to the fact that backlogs in terms of service delivery will be resolved once the new Civic Affairs Establishment is approved and implemented fully. However as of now the establishment has not been funded thus vacancies cannot be filled.

The delegation enquired why ID Statistics from Provincial Manager’s Office and Regional Office differ i.e. 900 and 1100 and the Provincial Manager replied that his office is only having statistics ending 14 October 2005 while the Regional Office is submitting stats up to date. As ID`s are distributed weekly the office also receives new books.

The delegation stated that this office has become a Regional Office and that establishment has expanded which means that the office is going to employ more staff. The provincial manager replied and stated that the Deputy Director post has already been advertised and he/she will have to ensure that all the remaining posts are filled.

The delegation stated that the office said that they are understaffed, so how do they manage to distribute ID`s especially during weekends by door-to-door delivery. Offices are open on Saturdays and skeleton staff are working whilst other officers are utilised to go out of office to distribute ID`s.

The delegation asked the management whether they have areas that have no service points to serve, if so how do they cover those? Management stated that they are working together with Traditional leaders, ward councillors and Social Development where they identify the areas with backlogs. Thereafter dates are secured for information sessions to communities where they are informed of the requirements for applications and after that dates are identified when the Department will collect applications.

• The committee was concerned as to what will happen when the contracts of interns expire on 31 October 2005, and Home Affairs relies entirely on them. The committee said that they would motivate that the interns be kept for another year because they do a good job.

• There is no sign board for direction of Home Affairs or stating HOME AFFAIRS PHUTHADITJHABA REGIONAL OFFICE

The establishment was discussed with members of the committee where it was explained that there are 13 clerks, 5 supervisors and two vacant posts The shortage of staff was discussed and they were informed that supervisors are also performing functional tasks.

There are 3 permanent service points, namely Viljoenskroon, Parys and Heilbron and mobile units are visiting Edenville, Koppies, Steynsrus, Lindley, Vredefort, Deneysville, Oranjeville, Petrus Steyn, Hennenman and Ventersburg, only once per month due to staff shortages.

ID’s are distributed door-to-door or posted to serviceable addresses but at this stage there are many identity documents in the office due to the problems experienced with the franking machine.

The lease of the building has expired and the contract has been renewed on a month-month basis. The condition of the building is not satisfactory.

Some of the staff members still do not have user ID’s and computers/printers are off line most of the time due to the new service provider (SITA).

The delegation enquired why the Arrival & Departure totals so high when Maseru Bridge experiences a staff shortage? The department replied that a number of businessmen residing in Ladybrand and commute on a daily basis to and from their businesses in Lesotho. The Cross Border Permits also allow Lesotho-and South African Nationals to cross the border without hassles in order to conduct business in both countries.

The delegation wanted to know how rife is corruption at the ports? The department stated that corruption is rife at the ports because of a lack of manpower and a lack of proper systems. Officials make themselves guilty of corruption by fixing passports of foreigners and taking money from persons who have overstayed.

The pedestrian facilities at Maseru Bridge are closed because there are no officials to man this clearing point.

The department stated that here are no official unmanned borders on the Lesotho/South African borderline. The South African Defence Force is currently responsible for the borderline.

There is sufficient/ adequate transport and even vehicles to transport officials between the workplace and their residences.

1. SOCIAL DEVELOPMENT

The delegation enquired into Foster Care and wanted to know whether there are any delays w.r.t. the Department Of Justice, whether applications are delayed? At the regional courts there are backlogs and the MEC stated that there are delays with regard to the Department of Justice and that the department is in the process to alleviate the situation e.g. they have campaigns with other stakeholders, a new computer system is being developed to fast track the process and that they have to strengthen the relationship with the department.

With regard to the roll-over of the budget, the MEC stated that there were roll-overs to the value of R250 million, and the HOD further noted that the roll-over was due to the fact that there was a delay in the adjudication of the tender process, which is centralized and that the tender was awarded at the end of the last financial year. He further noted that it was the first time that money was rolled-over.

On the issue of the upgrading of pay points the HOD stated that 54 pay points was upgraded to make it more conducive for beneficiaries, and with the current budget the department have to prioritise which pay points to upgrade. He further noted that security at the pay points is part of the department’s programmes.

With regard to old age homes the MEC stated that conditions are unacceptable in the Free State and he stated that the Historically Disadvantaged Individuals (HDI’s) are not benefiting from this. Every Old Age Home that is funded by the department must report to the department and the department is also funding about 50 luncheon clubs in the province. The department is also running a 24hr call on the abuse of older persons.

The HOD stated that they do provide for people with disability at pay points.

The HOD stated that many of the social workers apply for government positions, with the result that NGO’s are battling.

Members of the delegation voiced their concerns regarding pay out of the grants and whether grants on a particular day are pay out are the same day, the reason being that for e.g. beneficiaries coming for the CSG, must push the old age out of the way. The MEC noted that there are different pay out dates for the different grants e.g. CSG and Old Age Pension

The department highlighted to the delegation that beneficiaries are informed well in advance of the lapsing of their benefits and this is done in writing.

• Lack of Home Affairs documents
• Decrease in the volumes of applications
• Impact of the indemnity process
• Alleged fraud by caregivers
• Poor access of service by farm communities

• Provincial business plans focused on the registration and awareness drive has been completed
• Specific operational plans for each district have been completed
• Strengthening partnerships and joint campaigns with, Home Affairs, Education, Health, Municipalities, NGO’s etc.
• 40 additional staff have been appointed
• additional computers, printers, scanners and photocopiers have been procured for all the district offices
• Additional vehicles including 10 mobile offices have been procured, to reach out to farming and rural communities.

• Inadequate funding for ECD centres. Only 32% of the 74 000 children from the poor communities/families are benefiting form government funding. Current subsidy of R4.50 per child per day basically provide for food.
• Shortage of social workers to provide intervention and statutory services to children. Currently 259 social workers available and the national norm are 549.
• Inadequate funding to NGO’s to apy market related salaries
• Handling of backlogs of about 2075 i.t.o. intervention and statutory services
• Shortage of Places of Safety
• Inadequate facilities for statutory placements of multi-disabled children
• Successful implementation of the Children’s Bill
• Competent personnel
• Street Child phenomenon

• To obtain additional funds for more social workers
• Consideration be given to funding of NGO who will specialize in the selection of training of foster parents
• The establishment of residential places of safety in those areas where needed
• Establishment of a residential Child Care centre for children with disabilities as well as group foster homes.

• Shortage of Probation Officers
• Training and capacity building of personnel especially those rendering services in residential care facilities
• Roll out of Home Based Supervision Programme in all districts
• Insufficient resources for after hour assessment of arrested children and effective monitoring of children place in diversion programmes
• Delay of finalisation of cases resulting in blockages in DSD facilities
• Lack of reform schools for further rehabilitation of children.

1. Meeting with Concerned People Against Abuse (CPAA) at Kamohelo Heaven, Thaba Nchu

CPAA is a CBO rendering services to victims of abuse in Thaba Nchu and the Trust Areas. The following services are provided for:

• Accommodation for woman and children
• Support and counselling to victims at the shelter
• Referral of victims for medical attention when needed

Since 2002 the shelter accommodated 479 women and children. Cases handled by the Social Worker after-hours form June 2004 until April 2005 was 223.

• Marketing of services/shelter to other areas to utilize the shelter effectively
• Recruitment of people from the community to form part of the organisation and management
• Appointment of a shelter manager to help with the day-to-day running of the shelter. The need was identified and will be budgeted for 2006/07
• No assistance from municipality
• No salaries/stipends for volunteers
• No contract that building was donated to shelter

The Chairperson of CPAA stated that the volunteers at the centre are always there when they are needed and as from 1996 they have not received any monetary compensation to date.

She further noted that the shelter does not get any assistance form the municipality.

The building belongs to the Provincial Department of Social Development and she stated that it was donated to the shelter, but there is no contract stating the fact.

The SA Police Service use to take victims to the hospital.

• There is rooms for administration and counselling
• One room is for the matrons with 2 beds
• There are 9 beds for victims and the rooms are clean and tidy.
• There is security at the gate and it was stated that there is very little break-inns
• There is a laundry and the machines are all in well working order.
• During the tour the delegation met with a woman who is a victim of abuse, where the boyfriend wanted to kill her and her two boys. The victim stated that they are well looked after at the shelter.

1. Meeting with management of Boiketlong Old Age Home

Boiketlong is a government institution and the budget allocation for 2005/06 is R4 835 569.14 and the institution renders a 24hr residential care service as well as, balanced meals, a safe environment, primary health care services, access to secondary health care services etc.

The staff structure of cares personnel rendering 24hrs services: 1 Chief Professional nurse, 1 senior professional nurse, 6 Nursing Assistants and 12 care workers. The staff works on shifts between 07h00 – 16h00 and 07h00 – 19h00during the day and 19h00 – 07h00 during the night to sustain the 24 hour service.

1. Challenges

• The newly approved staff structure makes provision for five professional nurses. Presently there is only one senior professional nurse.
• There is a need to appoint an administrative officer to assist with the administration. Currently there is only one Snr Admin Clerk.

• The kitchen has stoves which is in perfect working condition (enquired from caterer)
• The catering has been outsourced
• The food supply is adequate (shelves was packed with food)
• Older person’s receive 5 meals a day
• The ones living in the rondawals eats in the halls
• Each rondawel has a bed, a cupboard and ablution facilities is in the hall.

1. Meeting with Regional Manager of Social Development: Kroonstad

1. Social Security

The presenter highlighted the number of beneficiaries, physical infrastructure of pay points, and access to grants at the various pay points in the region.

2. Indemnity process

The process went well and 897 different grants in the district were stopped. The process is still continuing with the Compliance Officer investigating cases reported after the deadline and action taken e.g. stopping of grants and recommending re-payments in some cases.

The presenter informed the Committee that as from 2003 a Probation Unit was established within the department and currently there are 4 Probation Officers and 2 Assistant Probation Officers for the whole district

The main focus is to do assessments to all arrested children that are reported to the department. In Kroonstad the Probation officer visits the court every morning to check if there are any children to be assessed, and the reason for this is because the SAPS report not all of the cases to the department.

These visits are done to avoid children being given sentences for minor offences and impacting negatively on their future.

The Probation Officer and the Assistant probation Officers also visit the prison once a week.

The presenter informed the Committee that in the last 6 months 314 assessments were done in the district.

The presenter also gave a brief background on the Secure Care Center, Matete Matches. The capacity of the center is 40 children, i.e. 38 boys and 2 girls; currently there are 27 boys and I girl. Programmes at the center include: art and craft, drama and culture.

The department provides 100% funding to the center annually and in terms of the Memorandum of Understanding signed between the department and the center, the department is also responsible for the monitoring of the center to ensure proper utilization of funding as well as effective service delivery.

The district was allocated a budget of R5; 8 million for 2003/2004 and the same amount for 2004/2005 and 19 422 food parcels were distributed to 6474 households over a period of three months in both financial years.

For the 2004/05, the identification was through Stakeholder Forums that were established when public meetings were held in all the 15 towns.

• Only 346 food parcels were issued till the end of September 2005. The MEC’s gesture to issue out food parcels to the needy and destitute for the festive season will contribute to spending all the funds. Social security relies in social workers to hand in reports to issue out food parcels.
• The lapsing of temporary disability grants has caused hardship for a lot of people, and many of them have appealed, but their still awaiting assessments and their grants have stopped before the outcome of their appeal.
• The district is struggling to reach the target as set for the children 11-14 years.
• With regard to children awaiting trial, not all children that are arrested are reported to the department for assessment.
• Court cases take to long to be finalized and children stay for long periods even for more that a year at Matete Matches Secure Care Centre
• Resistance of the Court to refer children to the center due to the absence of security, which leads to abscondment.
• Limitation of capacity at Matete Matches for children who committed serious crimes who end up in prison.
• Due to unemployment and poverty everybody feels that they were legible to receive food parcels
• Venue for distribution was a problem
• Safety of officials was at stake, where they were threatened

1. Meeting Regional Director of Social Development: Qwa Qwa (Thabo Mofutsanyane)

Thabo Mafutsanyana District has an overall population of 725,939. Maluti-A-Phofung has been declared a presidential node. The nature of leadership is traditional leadership and political leadership (councilors). Traditional leadership is very strong at the community level (villages).

The presenter informed the Committee on the location of offices/sub-offices and satellites, also the institutions e.g. Leratong Children’s Home and Thekolohelong Welfare Center.

She further highlighted the status quo regarding the personnel profile of the various offices in the region, including Qwa Qwa District Head Office, Bethlehem Sub- Office, Ficksburg satellite etc.

The challenges, as indicated by the Regional Manager includes the following:

• shortage of Social Workers, Community Developers. The remote rural areas are not attracting skilled experienced personnel.
• Backlogs in service delivery especially foster care applications

There are currently 19 children that are awaiting trial in the region

• Children are kept for long periods in the police cells, before being taken to alternative care like Matete Matches

Allocations were done according to municipalities.

Maluti-A Phofung 13 216

Lihlabeng 3 428

Setsoto 7 584

Nketoana 1 593

Phumelela 3 085

• Facilitation of formation of forums for identification and distribution
• Role of clarification between the department and the Municipality. There was confusion who was in control. The criteria for identification of beneficiaries not clear and concise. The object of the programme not fully understood by communities and politicians at local level.
• Delays in distribution due to suppliers stock shortage
• The contents of the food parcel not user friendly to a family without an income. Samp, beans require electricity or wood to be prepared, i.o.w. it defeats the objective.

The presenter explained to the Committee that some of the pay points were upgraded according to the norms and standards.

• Documentation is still a problem where both biological parents and children are without documentation.
• Lapsing of grants, which demand direct physical follow-ups to enable the applicant to meet the doctor. At times it is difficult to locate the address or the address has changed since the initial application.
• More transport and officials with driver’s licenses are required to ensure follow-ups on lapsed grants are made timeously.
• Entering into farms still a challenge although they are aligning their visits with the Department of Health with their mobile clinic visits is helpful.
• Vandalization of upgraded pay points and service points by communities rendering the efforts made by the government futile
• Unavailability of farm workers during the week when departmental officials are at work. Consequently visits have to be organized.

With regard to NGO and CBO funding the presenter informed the committee on the following challenges regarding the funding of CBO’s and NGO’s.

Challenges

• Lack of capacity on the part of the funded organizations to comply with the memorandum of agreement. Training was given, they were work shopped, but still compliance is difficult.
• Late payment of organizations by the department
• Effective monitoring and evaluation and evaluation of funded organizations by the department provincially and locally.

Due their culture and traditions the number of child headed households is very little as extended family members come forward to foster immediately the biological parents are deceased. Also with sibling households some children affected by the death of their parents and being old enough to can care for their siblings they still leave the responsibility with elders in the extended family.

There are 3856 families that are receiving foster care and 11568 children who are fostered and 650 file backlogs for foster care application cases awaiting home visits and compilation of reports.

• Shortage of social workers
• Shortage of transport for social workers to intensively intervene and follow up on cases
• Lack of co-operation with some magistrate court regarding foster care applications. Magistrates not appointed as commissioners of child welfare
• Escalation of HIV and AIDS related deaths increases the demand for foster care
• Interpretation of political statements by communities creates dependency on the system.

The presenter gave the following information regarding the indemnity process in the region:

• Bethlehem – 354
• Qwaqwa – 1845
• Senekal – 128

TOTAL - 2327

• Recruitment of social workers for tertiary training is done at matric level to address the current escalating demand for social workers.
• Training of social workers by tertiary institutions to be aligned to the current demands for service delivery, and this will enable incoming social workers to be prepared for the situation.
• Foster care application process to be reviewed, especially where proof of death of both biological parents is available.
• Availing resources to the social workers to perform their functions effectively, e.g. transport is always a problem.
• Clear and better systems be put in place for organizations mismanaging funds.
• Officials with financial management expertise to be employed at district level.
• NGO’s/CBO’s to be empowered/capacitated to administer food distribution. Food distribution always takes precedence over actual service rendering.
• A blueprint on procedure to follow for situations where the parent and the biological children are without documents are availed by the Department of Home Affairs as an information leaflet.
• The issue of unknown parent in the case of single parent death is clarified as to the investigation procedure of the whereabouts of the reputed parent. This is still a very sensitive issue.

• In the admin. Block there is offices for, the transport officer, registry, manager’s office and the switchboard
• At the foyer the disciplinary code and procedures
• The Acting manager informed the delegation that all children are attending school except for 3 boys
• There are currently 114 children at the home
• There are no air conditioning in the rooms
• There are 32 care workers
• In the girls block the girls eat separately and they have their own bathroom facilities and 5 girls per room
• The children are getting pocket money according their age.

• The pay point which the delegation visited is a tribal pay point
• 3000 to 3500 beneficiaries receive pay outs at this pay point
• Payouts are being done in period. e.g. 1000 people a day
• There is sufficient shelter at the pay point
• There is sufficient space and chairs for beneficiaries
• Ablution facilities are in a good condition
• On the day of the pay outs members of the luncheon clubs assists
• The Regional Manager stated that pay outs if from 08:00 am to 11:00 am
• She further noted that people are aware on which days they are to be paid
• Vandalism is a frequent occurrence at the hall
• The Regional Manager informed the delegation that payouts use to take place at the school (which is opposite the pay point), but a need had arisen to obtain another venue for these payouts, for this reason Social Development identified this hall.
• There is a fence around the hall
• Security is also visible at the hall

The HOD briefed the Committee on the following:

The number of people living with HIV & AIDS is about 487 772 and it is estimated that there will be 62 517 births, of which 4 366 babies will be infected at birth.

• Prevention programmes – 85%of frontline primary nurses health care nurses have been trained in the Syndromic Management of STI’s, and 1,6 million male condoms have been distributed per month and female condoms have been distributed to from 18 functional sites. VCT has been established in all 81 towns and is available at 242 health facilities. Training of 175 NGO’s in the past two years in financial, personnel and project management.
• Home Based Care (HBC) – this programme has been established in all 81 towns and is currently expanded to 10 farms in the province.
• Implementation of ARV – the Free State implemented 5 ARV sites, one per district and the plan is to implement another 5 ARV sites, for each district.
• Prevention form Mother-to-Child Transmission (PMTCT) – it has been extended to have one PMTCT facility per district, with 140 feeder clinics and 30 hospitals participating. Midwives working at maternity facilities are rendering the service.

The clinic committees are functional in more than 90% of the clinics. Challenges include: training, attendance, transport, identity and motivation.

With regard to the Hospital Revitalisation the province received R113 m and actual spending up to 30 September 2005 was R18m (16%), the infrastructure grant the province received R47m and R11, 7 m (25%) was spent (30/09/2005) and clinic building and upgrading received R21, 4 m spent (as at 30 September 2005) R4m (19%).

Xhariep District Facilities:

• Clinics: 17
• Community Health Center: 1
• Mobile clinics: 20
• District Hospital Complexes: 2

Motheo District Facilities

• Clinics: 63
• Community Health Center: 2
• Mobile clinics: 13
• District Hospital Complexes: 3

The Regional Manager briefed the delegation on the District hospitals within the region, Pelonomi Hospital that is a regional hospital; Dr JS Moraka Hospital and its available services, clinic information, the upgrading of facilities and the environment, the equipment and quality of care.

From 1999 – 2005 5023 TOP’s was performed and the age profile are that below 18 years is less, with the over 18’s increasing.

VCT is not mandatory and it is a localized service in the hospital with a dedicated professional nurse.

Prevention of Mother- To- Child Transmission (PMTCT) was implemented in 2004 and to monitor the end results for follow up is difficult, due to no feedback and reporting is not systemized. Recommendation is made for the central reporting to be done locally for outcomes to be captured.

• High vacancy rates for professional nurses
• Recruitment and retention is difficult even rural and scarce skills allowances and headhunting
• Budgetary constraints for medication
• Maintenance to clinics and hospitals

• Agency nurses to cover the shortage
• Relaxed recruitment for rural areas
• One advance midwife has qualified and acts as consultant for other midwives
• Functional and active clinic committees at all fixed clinics
• Functional hospital Board for the hospital complex
• Recently purchased a park home to accommodate the EMS station
• Critical equipment purchased and delivered for the hospital complex
• Maintenance budget for the clinics has been increased.

The Regional Manager stated the hospital was built in 1973 and that it is not part of the revitalization programme.

The Regional Manager further noted that the hospital is experiencing budget constraints and that the hospital is going to overextend.

She stated that there are no 2-roomed structures, but in one area the community build a structure, which was used as clinic, which received the Premier’s Award, and this proofed that the people in this region are not a passive citizenry.

Dr JS Moraka Hospital has a trained professional infections nurse, which has a master’s degree to do research as well.

A challenge for the hospital is that the IT is not up to standard.

One trained nurse performs TOP at the hospital. They had two, but one left and the hospital is in the process to appoint another. On the issue of back street abortions, the Regional Manager stated that this is not performed in the region.

• Maternity ward

• The maternity ward is modified and painted
• There are 2 delivery rooms
• There is a doctors room for the doctor on call, which is furnished with a TV, a fridge and bed

• Post caesarian section

• Furnished with six beds
• The bedding is clean and tidy

• Sonar room

• It is under lock and key
• Equipment in the room is in good working condition
• Ablution facilities for disabled

• 1 room is set aside for the Department of Home Affairs for online registration
• new incubators was bought
• the ambulances for EMS is not well equipped and has the basic equipment
• there is a Occupational Health and Safety officer at the hospital
• pediatrics ward

• there are 20 beds
• security is visible at the front gate of the ward, for children’s safety

• nursing manager stated that if mortuary is full, the hospital makes use of private funeral undertakers
• the hospital has an eye clinic.

The Committee made an unscheduled stop at the clinic

• there is a dots room
• 3 consulting rooms
• sluice room
• 2 counselors
• 4 staff members working at the clinic
• in the pharmacy there is a shortage of medicines, and as stated by the Senior Professional Nurse (SNP), this is because of a shortage from Bloemfontein.
• The SNP stated that a major problem is the training of pharmacy assistants

The Regional Manager informed the delegation that Voluntary Counseling and Testing (VCT) is performed at all health facilities as well as PMTCT. The current number of patients on ARV treatment is: male adults 245, female adults 792 and children 30.

At Thebe Hospital the maternity ward and dental clinic have been completed and currently they are busy with the last phase, which includes EMS station and administration block.

At Elizabeth Ross the maternity ward, male and female wards, children’s ward, admin offices have been completed and they are now busy with the last phase, which includes the casualty, X-ray department.

No clinic upgrading took place in 2004/05 financial year and the priority list for upgrading remained the same for 2005/06 financial year. These priorities include: A total R10, 5m was budgeted in the region for equipment. The Regional Manager informed the delegation that 38% (R3, 974m) of the equipment has been purchased and paid for, 50% has been ordered and delivery is awaited. The remaining 20% is awaiting tender procedures as the equipment costs above R100 000. The region anticipates that at the end of the financial year 100% of the budget will be utilized.

• Shortage of personnel
• Accommodation for personnel
• Limited budget
• Equipment
• Staff recruitment and retention because of the rural ness of the area
• Maintenance of facilities
• Transport
• Roll out of HIV and AIDS comprehensive management, care and treatment.

The General Manager of the Northern Free State briefed the delegation on the structure and clusters, the institutional structure and management structure. He noted that Bongani Regional Hospital, Welkom is currently engaged in a twinning programme with the Royal Children’s Hospital, Melbourne Australia, and he stated that knowledge is shared between these two institutions in the field of paediatrics, specially the relationship between the community and the hospital and the care for children in the community. The General manager added that 4 hospitals in the region were accredited as baby-friendly in 2004.

The General Manager stated that all hospitals boards are in place and that all have business plans and that they are operational. Thirty five (35) out of 37 clinic committees in the region are functional.

With regard to the PFMA, managerial accountants was appointed, an internal control check list was developed and cost centre training took place while some hospitals have already implemented cost centres.

With regard to Emergency Medical Services (EMS) the General Manager stated the following challenges:

• EMS is rendered according to a provincial plan identifying three legs: pre-hospital, inter-hospital and planned patient transport
• Provincialisation of EMS from municipalities without any supporting infrastructure in smaller towns
• An ageing fleet of vehicles that also are being written off by irresponsible members of EMS
• Vehicle abuse including petrol card fraud.
• Patient transport across the province to receive higher levels of care e.g. a patient leave Villiers at 3am, arrive in Bloemfontein by 10am, leave Bloemfontein at 5pm and return home around 10pm.

The following challenges in the District was highlighted by the District Manager:

• Recruitment and retention of personnel
• Equipment and facilities maintenance and replacement
• Budget – over expenditure
• Dispensing licenses for nurses
• Finalize process of devolution
• Vehicles for service provision
• Provision of doctors at PHC level – session doctors not meeting needs of communities

Challenges:

• Maintaining standards that was set with accreditation
• Implementation of family health to address the level of burden of diseases.
• Implementation of the new Mental health Act to assure a comprehensive approach
• To reach Employment Equity targets by 2006
• Retention strategy for health professionals.
• To stay within allocated budget
• The replacement and purchasing of equipment.

When the delegation arrived at the hospital the first thing they wanted to check, was the ambulances and the equipment in these vehicles. The ambulance, which was parked outside the hospital, had no drip, but there was oxygen and the ambulance driver informed the delegation that it is working. The ambulance had a low kilometer reading on the odometer. The General Manager stated that the hospital has 26 ambulances.

• The X-ray department is going to be revitalized, where the current room is being extended
• They are in the process in ordering a new special machine, because the one machine they currently have is more than 10 years old and that it is very costly to repair.
• The general manager stated that R8m is being ring fenced for equipment.

• The hospital is in the process to finalize building of a brand new store
• A completely new out patients department and ARV site is also underway and they are envisaging finishing at the end of November 2005 and it will open in mid November 2005.
• Paving have been laid at the parking
• Doctors quarters are being build, which includes 22 flats (6 double rooms and 16 single rooms), also included are the parking bays at these flats.
• The theaters are being renovated (all 4), but 2 currently.
• A training college will also be built
• Accommodation for nurses is being built, which will include a TV, stove etc. in the flat. The Committee Secretary went to the flats and he informed the delegation that the accommodation that are being built for these nurses and doctors looks beautiful and that it will be a joy, once these buildings are finished, to live in these flats, the reasons being that it is spacious and comfortable (only about 100 meters away from the hospital).
• A training college will also be built, and the Nursing Manager informed the delegation that this will be very advantageous to the hospital, as nurses will be trained there and the hospital will show them the culture of the hospital, and at the end of their studies that they would not want to leave the hospital.

• 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 relevant Departments, and will continue provide oversight on departmental strategic plans to ensure that the relevant issues are taken up in strategic and operational plans.