The Select Committee on Social Services undertook a study tour to Gauteng Province from 7-9 February 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 visit included:

To conduct oversight over the management and quality of services rendered in respect of health, social development 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.

One of the biggest challenges facing the Department relates to t he need to move away from a welfare approach to a developmental approach. The Department is finding the developmental approach more challenging, and identified some additional challenges in this regard:

Unlike in the past, the new developmental approach to service delivery requires co-operation and partnerships between the various spheres of government, the non-government sector and the private sector. It remains a challenge to manage this process.

With regard to the food security programme, there is a ne ed to work closer with other stakeholders such as the Department of Agriculture.

Trial- awaiting children tend to stay much longer in secure care centres than what was originally intended. This becomes a problem as these centres were never constructed of hosting children in the long-term, and therefore does not adequately cater for such children.

While child-headed families has become a reality, and this is largely due to the impact of HIV and AIDS, and it has become a major challenge to the Department. Such children face the trauma of once having lost their families, faced with the added burden of heading households.

The Department’s strategic priorities are in line with its vision 2014 objectives of the Gauteng Province. The strategic objectives relate to the following priority areas:

Children and Families

Women

Older persons and people with disabilities

Youth

Social Grants

Transformation of the social sector

Poverty and HIV and AIDS

The removal of almost 30 000 temporary disability grants in 2004/05 has resulted in a saving of R153 million for the Department.

The prosecution of 706 dishonest members of the public regarding the disability grant resulted in a saving of R6,3 million per annum.

There is a campaign to improve the pay points, and a total of 10 pay points were upgraded since the current financial year 2004/05.

The waiting period for grants is no longer than 3 months after application.

The Department provides nutritional support to HIV and AIDS affected and infected children and families.

The Department links HIV and AIDS affected children with governmental services, e.g. grants and identity documents (ID’s).

A total of 70 community-based care sites are funded to provide care for HIV and AIDS affected and infected people.

A total of 10 drop-in centres are funded during 2004/05.

The Department funded 6 organisations to fast-track foster care placements.

The programme provides for, child-headed households, children living with terminally ill-parents, patients on ARV and TB treatment, persons awaiting grants and street children (homeless), but located in shelters.

The total budget for 2004/05 was R27 million, of which R14,4 million was utilised to date.

A total of 28 159 households were reached, of which included 112 636 children.

A total of 84 476 food parcels were distributed.

There were some delays in the distribution of food parcels, due to the awaiting of the national processes.

The Bana Pele programme for children was launched in November 2004, which means ‘Open Window’. The programme provides a package of services to children such as education, health and social services.

The Department developed 6 strategic priorities, from 2004 until 2009:

Promote health, prevent and manage illnesses or conditions with the emphasis on poverty, lifestyle, trauma and psychosocial factors.

Effective implementation of the comprehensive HIV and AIDS strategy.

Strengthen the district health system and provide caring, responsive and quality health services at all levels.

Implement the people’s contract through effective leadership and governance.

Become a leader in human resource development and management for health.

Operate smarter and invest in health technology, communication and management information systems.

A package of services is rendered, and VCT and PMTCT are considered key interventions.

PMTCT is offered at all public hospitals and large community health centres.

HBC is provided in every health sub-district, through NGOs, CBOs and volunteers.

The volunteers receive a 69-day training programme and can they support Tuberculosis (TB), HIV and AIDS, maternal health and care for the aged.

By the end of 2004/05, a total of 1000 volunteers will have received training.

The Department implemented a Patient’s Right Charter and Quality Assurance Programme.

Facility managers sign a performance agreement, but the system still need to be improved.

The Department is committed to PHC, and some facilities are open on a 24-hour basis.

Chronic medication is available in clinics.

The impact of migration from other provinces is worst felt on PHC level, and the situation is compounded by the shortage of staff.

The relocation of Natalspruit hospital is in the pipeline, since it is currently situated on a dolomite site.

In order to address the labour relations problems at the Hospital, management has been seconded from other hospitals to Natalspruit.

A dedicated labour relations officer has been appointed.

Equipment has been acquired and delivered.

The position for a Quality Assurance Manager has been advertised.

The filling of critical posts has become a priority, such as professionals, doctors and nurses.

The implementation of the provincial Employment Assistance Programme (EAP) has commenced.

The Department is seeking to rebuild and strengthen its relationships with unions and the community.

There is a process of continuous monitoring and evaluation in place. In January 2005, an independent audit was conducted to evaluate the strategy put in place by the Department.

The construction of the building is completed and the Department is awaiting the equipment.

The hospital will be operational during the course of 2005 and the placement of staff will also be done during this time.

Dr Pekane, CEO of Natalspruit Hospital, made a presentation to the Committee.

Natalspruit is a large regional hospital, situated in Kathlehong. The hospital falls under Ekurhuleni/ Sedibeng health region, and serves a population of 1,3 million. A variety of general, specialist and allied medical services are provided.

Since 1 April 2004 until 31 January 2005, following number of patients were treated:

Post Exposure Prophylaxis (PEP): 541 patients

Prevention of mother-to-child programme (PMTCP): 3604 patients.

Anti-Retroviral Therapy (ARV), since 1st July 2004: 5900 patients.

Voluntary counselling and testing (VCT): 1340 patients

Choice of Termination of Pregnancy (TOP: 1019 patients

Only staff members who volunteer to perform TOP are providing this service, and they have to apply in writing to indicate their willingness to undergo training.

There are a total of 1609 approved posts on the staff establishment, of which 1334 were filled. This suggests a vacancy rate of 17%.

The hospital experiences a high staff turnover, but exit interviews are conducted with staff on their resignation.

The hospital is situated in a township and struggles to compete with other hospitals in attracting and retaining professional and skilled personnel.

Despite being situated in a disadvantaged community, the hospital does not qualify for rural allowance, in order to attain and attract staff to the hospital.

Globalisation has an impact on human resources, as staff prefer to leave the hospital in order to practice abroad due to higher incentives/salaries offered in other countries, as well as to get internationally exposure.

Nursing staff resigns in order to access their pension funds, and then re-applies in the short term.

De-motivated staff, who have the relevant experience, but lack the formal qualification for a specific area, resign as their experience is not recognised without the formal qualification.

The community service doctors do not remain with the hospital on completion of their terms, but leave to open their own practices.

The hospital does not have a booking system and patients come to the hospital as and when, resulting in long queues.

In visiting the casualty ward, the Committee observed the overcrowding.

The Committee recognises that attraction and retention of staff is major challenge, and therefore, recommends that a Human Resources Strategy be developed to address some of the unique challenges faced by the Natalspruit hospital.

The Centre started in 1999, and is one of the projects funded by the Department of Social Development. In 2002/03 and 2003/04, the Centre received funding to the value of R280 000,. However, as yet, no funding has been received from the Department for 2004/05. The Centre provides services to children affected and infected by HIV and AIDS, which include:

a crèche;

after care for children attending school;

a drop-in centre providing food and clothing;

Home-Based Care (HBC); and

Traditional health services to treat HIV and AIDS affected children.

Currently a total of 130 children are registered at the Centre, which provide a free service to the children. Most of the children suffering from AIDS-related illnesses are affected by skin problems and stomach ailments. Children are treated with traditional medication (traditional practitioners) at the centre, or are alternatively referred to the local health centre.

Funding received from government is inadequate, considering the type of services offered at the Centre.

The building hosting Katha Daycare centre in Kathlehong Township is privately owned.

The building needs considerable renovation and adequate equipment in order to provide services.

The Departments of Health, Agriculture and Education are not involved with the project, but the Department of Health provides Home Based Care (HBC).

The Department of Education should be approached to provide funding for Early Childhood Development (ECD) services offered at the centre, such as Grade R.

The Department of Health should be approached to provide funding for HBC services, as well as services to children suffering from HIV and AIDS-related illnesses.

The Department of Agriculture should be approached to assist with e.g. the development of a vegetable garden.

Since the Department of Social Development funds the Katha Daycare centre, officials should assist the Centre management in obtaining private funding.

The office is situated in the Tswane Metropolitan municipality, situated in a cross-border area, providing services to people in both Gauteng Province and North West Province. The Office receives an average of 70 identity document applications on a daily basis. Applicants do not collect many of these. (The Committee observes that IDs are kept in a filing cabinet).

The current staff establishment is19, which includes two immigration officers. However, according to a work-study report, the proposed staff establishment makes provision for 49 people.

The office faces a critical need to increase the number of immigration officers in order to control illegal immigration from Mozambique.

The lack of human resources is compounded by the fact that the Department took a policy decision to end the services of volunteers.

The office is not situated on the ground floor and, therefore, is not easily accessible to disabled visitors.

The number of computers is inadequate with the result that two staff members are sharing a computer.

Data lines have been installed in the Office, and the hope is expressed that the IT system will be upgraded.

The control of the IT system is open to fraud, as "user identities" (passwords) are often used by unauthorised users.

Members of the public commit fraud in order to access child grants.

In many instances, religious leaders sell baptism certificates to potential fraudsters, to assist them in obtaining official documents.

It is reported that some school principals provide official stamped school letters in order to assist potential fraudsters.

The number of immigration officials are inadequate. In addition, they lack the necessary resources such as adequate vehicles to transport illegal immigrants and cellular phones in order to stay in contact with the office or each other on official urgent issues.

A directive issued by the Director-General terminated the services of all volunteers in the Department. Consequently, the office is facing a serious shortage of staff.

The Mabopane Office serves a cross-boundary area.

The two Light Delivery Vehicles (LDVs) assigned to the Office are not equipped for transporting the number of illegal immigrants to Lindela Detention Centre. There is a shortage of resources, noticeable computers, and the building desperately needs a serious renovation.

Due to the insufficient staff establishment, the Office faces a serious challenge in having to verify ID applications or alternative documentation, such as baptism certificates or school letters.

The Office has to provide services to people travelling up to 248 km, since offices closer to them do not have terminals to provide death certificates immediately.

The Home Affairs head office should ensure that the security of the IT system becomes a priority, in the interest of fraud prevention.

The Committee observed the critical need for human resources in the office and recommends that these issues become a priority.

There is a need to urgently review the staff establishment of the Mabopane Office. In addition, it has become critical for the Department of Home Affairs to recruit and appoint the relevant staff, especially entry level appointments.

Considering the problem with illegal migration from neighbouring countries, there is a need to appoint additional immigration officers in the office. These officers should also be equipped with the necessary resources in order to perform their function effectively and efficiently.

The Committee will follow-up with the Department regarding the lack of terminals that provides for the immediate printing of death certificates at some offices.

The Office has a total of four computer terminals, which is shared amongst eight staff members. This is clearly inadequate.

A total of 21 staff is currently on the establishment, and there are 3 vacancies in the immigration section.

The building in which the Regional Offices is accommodated is shared with two others departments and staff are not sure where the Home Affairs borders in the building stops for purposes of renovation.

The doors of offices cannot lock.

The building has no security, despite various requests for this service to the Head Office.

Provision is only made for staff toilets and none for members of the public visiting the office.

The building has an electricity problem, a leaking roof and the floor tiling needs to be renovated.

Vehicles to transport the number of illegal immigrants apprehended are inadequate to cater for the numbers.

When all three vehicles allocated to the Office is out, staff make use of private vehicles or public taxis to transport money for the daily banking.

Fraud with regard to official documents for non-citizens has significantly declined since mid-2003.

In many instances, religious leaders sell baptism certificates to potential fraudsters, to assist them in obtaining official documents.

There are a number of outstanding ID’s that have not been collected, but the intention is to deliver these with the assistance of the post office.

It is difficult to arrest suspected fraudsters due to lack of immigration officials, and in one instance the Office had to release a suspect in this regard, due to this shortage.

The lack of vehicles seriously hampers service delivery in the area and results in risks when revenue collected by the office is transported.

The building requires urgent renovations.

Provisioning is centralised and permission is granted from the Head Office for ordinary maintenance tasks such as fixing doors and toilets.

There is a need to ensure that the office has the relevant resources, especially vehicles, to ensure optimal service delivery.

The building requires urgent renovations.

The lack of security poses a serious risk, and the Head Office should make this a priority.

The Head Office should investigate how procurement can be more decentralised to assist effective and efficient service delivery.

The Committee received a presentation by Mr Barry Gilder, Head of Department: Home Affairs.

The Department’s Turn-around Strategy was formulated in September 2003, and is based on the key intervention areas of people, infrastructure and technology.

A process of review has been implemented for the Turn-around strategy in order to track progress and facilitate achievement of the key objectives and output.

The Department’s strategic plan for 2004/5 - 2006/07 identifies ten critical intervention areas:

Immigration

Civic services

Service delivery

Leadership and management

People

Infrastructure

Finance and procurement

Information systems

Corruption

Government Printing Works (GPW)

Significant progress has been made in some areas whilst others have been slower to get off the ground, but are catching up.

Resource constraints hampered the effective operation of the Department in the past and it will be essential for the Department to fund and fill the critical posts, in order to improve service delivery, and then sustain the new levels of service.

The appointment of employees, and especially top management who can lead the change for units in the Department, has been a turning point.

The main components/projects within HANIS are:

Identification infrastructure – all equipment has been delivered and installed within the Department and the contract is in the maintenance phase, which draws to conclusion in March 2006.

Back Record Conversion (BRC) – conversion of records to commence in March 2005, and the date of completion will be September 2006.

Population Register (PR) – system to be implemented by end of 2006.

Immigration Control System – VISA and Border control system is to be completed by end of 2005; full immigration Control System to be procured and awarded within 2005; rollout of the complete system to commence in 2006 and to be completed by late 2007. The refugee system, together with the Refugee ID Card System, should be functional by April 2005. Business users trained

EPassport – the rollout of new ePassports will commence in 2006, and the process will continue until 2011.

Smart ID Card – the rollout of smard card is a five-year project spanning 2007 to 2012.

The Immigrations Regulations drafting team has completed:

Draft Immigration Regulations

Regulations on fees in terms of section 7 of the Immigration Amendment Act (no. 19 of 2004).

The draft regulations were published for public comment on 31 January 2005.

A survey conducted in the Department indicates that only 40% of the staff ever heard about the Turn-around Strategy. The thrust of the operational planning for 2005/06 is to communicate the Turn-around Strategy to staff.

The Committee expressed its concern about the rollovers in the Department, and questions the capacity of the Department to spend its financial resources.

The Committee recommends that the Department computerise the filing system in regional offices.

The Committee expressed the intention that issues such as the centralisation of procurement and the lack of acknowledgement to complaints received from the regional offices should be addressed and incorporated in the Turn-around Strategy.

The District is faced with many challenges, but has also experienced a number of successes. One of the main challenges facing the District is that of poverty and unemployment.

As a result of the high unemployment rate, communities are experiencing high levels of poverty and are, therefore, unable to pay for rates and services. This situation resulted in the financial situation faced by the local municipality.

The District concluded its Economic Development Strategy in 2004, but still has along way to go.

The Economic Turn-around Strategy focuses on tourism and agriculture, which addresses issues of food security, as well as production for markets. It is argued that agriculture has always been the backbone of the Gauteng economy, despite declining in the contribution made to the GDP. It is, however, anticipated that agriculture can still make a significant contribution to the provincial economy.

The District has an indigent policy, but it needs to be revised to address some of its weaknesses.

A total of 100 346 beneficiaries are in receipt of grants in the District, of which 65 239 are residing in the Emfuleni local municipal area.

A total of 17 pay points are making cash payments to 86 765 beneficiaries.

A total of 2934 children are in foster care.

A total of 243 households are headed by children, of which 209 are beneficiaries of the Food Security programme.

A total of 17 youth are awaiting-trail at Leeuhof Prison.

The following NGOs are funded:

Prevention and Protection of Children and Families: 16

Offender care and substance abuse: 8

Prevention and the protection of the disabled: 3

Prevention and Protection (CHBC): 8

Early Childhood Development (ECD): 20

Shelters for children working and living on the street: 2

Shelter for abused women: 1

Children’s Homes: 4

Homes for the Elderly: 4

Community-based luncheon clubs: 14

Home for the disabled: 1

Protective workshops: 3

Development Centres: 2

The District signed a Memorandum of Understanding (MOU) with the province to deliver PHC, however, this process has been delayed. The Sedibeng District Municipality has budgeted for the PHC function until June 2005, but there is uncertainty what is the process going to be after this date.

With regard to access to pharmaceutical products, members of the community go straight to hospitals to access drugs, instead of their local clinics. There is an existence of a shortage of drugs in the region. A variety of reasons are given for the drug shortage, varying from Supply Chain Management (SCM) to issues relating to management capacity.

With regard to public participation, Ward Health Committees are established in all three local municipalities:

Emfuleni - of the intended 43 Ward Committees, a total of 17 has been established, and training provided to 10 of the Committees.

Midvaal - of the intended 9 Ward Committees, a total of 3 has been established, and none of them received any training.

Lesedi - of the intended 11 Ward Committees, a total of 8 has been established, and training provided all 8 of them Committees.

Monitoring and evaluation of Ward Committees is done at local area for further development of Committees, and training will be ongoing until all the wards are established.

Establishing Ward Health sub-committees in predominantly white urban areas, as well as rural areas remains challenge.

Securing funding for the operational activities and training of Ward Health sub-committees, similar to that for Hospital Boards.

Sustainability of Ward Health sub-committees.

Monitoring and evaluation of NGOs to ensure compliance with legislation and policies.

The Management team of the hospital is relatively new and a number of heads of departments were appointed during the previous year.

The hospital has a 27% overall vacancy rate

The hospital is experiencing a shortage of professional nurses, since those who complete their training do not apply to work at Sebokeng, but prefer working in the private sector or abroad.

Despite stringent advertising, the hospital could only manage a total of two posts out of the 15 advertised.

Sebokeng will go through a vitalisation process and the Folateng-section is almost ready for occupation. This process is driven by the Department of Public Works.

The hospital regained accreditation for an internship programme, and as from 2005 will have medical interns.

The Hospital Board is fully functional.

The hospital provides pharmaceutical products to surrounding clinics. The aim is to strengthen local clinics with poor infrastructure by deploying doctors from hospitals.

The hospital is going through an accreditation programme and is currently on level 3 of the rating scale. In order to improve its rating, the hospital will have to address some issues, but this will be re-evaluated in April 2005.

It is anticipated that the hospital will not overspend on its budget for 2004/05, due to cost containment measures implemented when an over expenditure was projected.

Some of the machines in the hospital is not in a working condition, however, the hospital has already exhausted its budget for equipment and has to rely on other hospitals for this purpose.

The referral system is not working, and the hospital is unable to turn patients away.

The hospital has a shortage of professional nurses, and has not been very successful in efforts to attract new staff.

The Committee will be returning in approximately three months to assess the progress made with regard to the accreditation process.

The Committee observes that the Casualty department is not patient friendly.

The clinic provides comprehensive health care services, and operates from Monday to Friday from 07h00 – 16h00.

It is also a National Adolescence Clinic Initiative, which provides youth-friendly services, and is also a clinic that other smaller clinics refer for further management.

The clinic provides the following services:

Voluntary Counselling and Testing (VCT) - Clients are counselled and tested and those with opportunistic infections are referred to the PHC sister within the facility. Those with Tuberculosis (TB) are treated and referred to Anti-retroviral therapy (ART) for further management within the facility.

Prevention of Mother-to-Child Transmission Programme (PMTCT) – the programme started in November 2002, and provides Nevirapine to HIV+ pregnant women. Since the provision of ART to pregnant women, they are more willing to be tested and the statistics are increasing on a monthly basis.

ART – the clinic is amongst 23 sites identified for ART rollout. The programme was intended to start in January 2005, but due to community demand and good support from the management, rollout started in October 2004.

Termination of support grant, although patients are on ARV and unemployed.

Shortage of human resources, especially registered nurses and pharmacists.

Limited space, especially in the waiting area.

Newly employed staff, with significant experience, starts at entry level salaries.

The centre was developed for the upliftment of the community, and provides the following services:

Children’s Residence Centre – provide care for children infected and affected by HIV and AIDS. There are currently 38 children in residence. Children are placed in the centre by the Department of Social Services through a statutory process. The intention is to re-unite children with their immediate or extended families or placement with foster parents.

Home-based care for persons affected and infected by HIV and AIDS.

A Hospice – with a total of 18 beds for the terminally ill. Terminally ill patients suffering from HIV and AIDS and cancer are referred by local clinics.

Poverty alleviation projects

Skills development and job creation – 60 people from the local community were provided with building skills.

A community function room – to host functions.

A youth development programme – one member of the youth is doing an internship with the centre.

The centre is the result of strong partnerships between the public and private sector:

The physical infrastructure was donated by the South African Manganese Corporation (SAMANCOR) for use on long-term basis, rent-free. In addition, SAMANCOR is responsible for the water, electricity, maintenance of the buildings, garden services and security of the centre.

Fedics Food Services is paying the salary of the centre manager.

A medical doctor is providing services free-of-charge to the Hospice.

The Department of Social Services provides a subsidy for each child in the Children’s Residence Centre.

The Department of Health funds the community health workers and the Home-Based Care programme.

The centre needs to establish a partnership with the Department of Education in order to fund Early Childhood Development (ECD).

The centre has not been officially launched, and the Board Members are requesting that the Committee assists in getting the Minister of Social Development to visit the centre and officially launch it.

The board members should approach the Department of Education to fund the ECD activities.

The Committee will approach the Minister of Social Development to formally launch the centre.

The management board should be more gender representative.

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.

Report to be considered.