Report of the Select Committee on Social Services on Oversight Visit to the North-West Province, dated 7 June 2005:

Report of the Select Committee on Social Services on Oversight Visit to the North-West Province, dated 7 June 2005:

The Select Committee on Social Services, having undertaken an oversight visit to the North-West from 14 February 2005 to 16 February 2005 reports as follows:

Background

The purpose of the study tour by the Select Committee on Social Services to the North-West Province is for the Committee to exercise its oversight function as delegated to it by the National Council of Provinces. The primary objectives of the provincial visits included:

To conduct oversight over the management and quality of services rendered in respect to 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.

Bojanala District Municipality, Department of Health

The presenter stated that the strategic goals of the region are in line with the Health Care Act and the

Ten – Point Plan of the National Department of Health. She stated that the presentation will focus mainly on the MEC’s budget speech and this is to give information regarding the District during the MEC’s Roving Exco.

Primary Health Care Special Programmes and TB cure rate:

With regard to the TB cure rate the norm is 85% and the district average is 56%. The number of VCT sites established in the district increased at some hospitals e.g. in the 3^rd quarter 2003/4 Moses Kotane had 20 sites established and in the 3^rd quarter 2004/5 it doubled to 40, but in Odi in the 3^rd quarter 2003/4 it decreased from 14 to 10 in the 3^rd quarter 2004/05. Rustenburg is the worst hit by TB, the reason being that in the area there are many mines and at these mines there many immigrants, with the result that they don’t go the full cycle. The district does have a strategy in place to deal with the situation but it remains a challenge.

VCT and PMTCT sites:

The district are experiencing problems, because there is a stigma attached to HIV and AIDS, but the Department promotes that people should come forward.

HIV/Aids ARV Rollout:

With regard to roll out of ARV, Rustenburg Hospital is providing this service in the region.
Brits has identified a "Pre-fab" building for this use.
Jubilee has renovated an area for the service and the staff is available
Odi and George Stegman Hospitals will be visited to identify sites for the progamme.
Hospice in Phokeng is providing the service. Staff need to be trained in the assessment of patients

for compliance.

Care to disabled:

50 disabled people received wheelchairs
10 people received white walking sticks
40 hearing aids were distributed to the needy.
The district is trying to make buildings user friendly for disabled

Hospitals:

Batho Pele monitoring waiting time in Odi and George Stegman Hospitals is within the norm and Jubilee Hospital improved. The Brits and Koster Hospitals need to improve. The question of patient satisfaction survey George Stegman and Jubilee are doing well on this indicator. It was stated that surveys should be done 6^th monthly.

Mental health:

6 mental health coordinators were trained on the implementation of the new Mental Health Act

Budget:
The bulk of the budget was spent on personnel.
Termination of Pregnancy (TOP):

The presenter stated that most of the district hospitals perform TOP. She further added that nurses could refuse to do TOP, due to religious reasons. The district does have a Waste Management service in place to properly dispose of TOP. There are containers for TOP and these are not disposed with other products.
Comments from Department of Health:
All except Koster perform TOP.
The question on the motivation of staff e.g. incentives (rural allowances, scarce skills allowances) will encourage staff. Rustenburg Provincial Hospital is not seen as rural, i.o.w they do not qualify for rural allowances, they are presumed to be urban. Nurses do get night duty allowance and scarce skills allowance, however salaries in the public sector cannot compare with that of the private sector.
The delivery of pharmaceuticals to clinics is outsourced.

The Strategic goals of the district are linked to the Ten-Point Plan of the Department of Health and the goals have been put according to the legislative framework.

The district is not reaching its targets, the reason being that most clinics do not have the Primary Health Care (PHC) Package. There still is a shortage of staff and equipment.

The staff establishment is determined nationally; there is little the district can do about it. The establishment has to be revised.
Personnel are the biggest expenditure and what is left, is divided to other items.
The VCT increase at Madibeng was due to the fact that they got 2 clinics from Odi District.
Challenges:

Emergency Medical Services (EMS)- there is not enough stations to reduce the waiting time. This is

related to shortage of staff and vehicles

Budget shifts- as displayed, the allocations as requested on the MTEF and the adjustment budget did

not address the problem

Professional Nurses shortage- the community expects all clinics to provide 24 hours service including the 2 roomed structures. 1 professional nurse mans clinics that provide 5-day only service. Unplanned sick leaves interrupt service delivery. High staff turnover may be related to poor conditions of service.

Odi cross border remains a thorny issue.
Recommendations:

Vehicles- 60% of the vehicles have seen their better days. New pool of vehicles needed

EMS- Health centers will need to have one ambulance to address P2 and P3 cases

Budget- Finance Directorate to allocate funds according to regional MTEF request

Staff shortage- staff establishment need to be revised because this was last done in 1996.

Department of Social Development

The budget for Social Development in the region is overspent. Social Development are busy trying to improve pay points. Officials at pay points received cell phones and a laptop, budgeted for by the Department for easy communication in case of enquiries. The pay points will be a challenge because some of them require tents, chairs and other facilities. The department did allocate money for renovations in 2002. The Department did award a tender, to a Mr T, where he has to supply tents and chairs at various different pay points.

The Pensioner Committees at the various pay points also assists very well with order at these points. A challenge of the department will be the Foster Care Grant where there is a shortage of staff (Social Workers), which results in a delay in administration. Another challenge for the region will be HIV and AIDS, where many children are orphaned (i.e. parents dying).

With regard to the Trial Awaiting Children there are 9 Probation Officers. There is one secure center in Bojanala, which has place for 45 boys. For the next financial year the region submitted approval to build 2 more Secure Centers. The current situation is that these children are taken to police cells and the police ensure that they are separated. The police and the department ensure that the rights of the children are protected.

With regard to Food Security the region has lots of challenges. The food parcels are to assist those who receive less than R200 a month, or who has no income or hit by HIV and AIDS. The challenge is that there are not sufficient food parcels to service everybody.
Comments from Department:
At various pay points, Service Managers have been appointed to assist in service delivery. Officials have been found to be corrupt and these cases are ongoing. With regard to Child Headed families, children under the age of 14 years do not qualify, but they may qualify for the Foster Care Grant. Recommendation is made that the department link with other stakeholders e.g. Education and Health. The Municipality is busy with a list of poor families within its region.
There are delays in the Child Support grant and this occurs where there are no certificates and a recommendation is made that there will have to be a link with the Department of Education and other departments. The department of Agriculture is assisting with regard to food parcels.

If child labour is reported in the region it will be addressed as soon as possible.

The Regional Department of Social Development is linking with other departments e.g. Education and Health. The Department of Agriculture are assisting with poultry farming and bricklaying. The department is not working in isolation but the activities have to be synchronized with other state departments.

There are volunteers at the different pay points.

Beneficiaries are reviewed once a year.
With regard to beneficiaries not receiving money due to administrative problems, the beneficiary will receive his/her payment from the day the application was received.
Challenges:

The budget for Social Development in the region is in the red.

Shortage of staff, especially social workers.

Queuing of beneficiaries at pay points. At some pay points there are no chairs or facilities.

The foster care grants are a challenge because of the lack of staff (social workers) and the delays in administration.

Because of HIV and AIDS many children are orphaned.

The number of probation officers, relating to trial awaiting children. The building of Secure Centers to house these children, because currently the children are taken to police cells.

With regard to food security, the food parcels are not sufficient to service every beneficiary.

Recommendations:

The Department of Social Services in the district have to involve various other stakeholders e.g. private sector

The department has to link with other departments e.g. Education, Health, and Agriculture etc.

At different pay points there are hawkers selling products and a recommendation is made that these hawkers sell their products outside a certain radius made by the department (e.g. behind a fence)

Visit Classic House Clinic- Rustenburg

Classic House Clinic is situated in the CBD (Central Business District) of Rustenburg. It started 7 years ago and the building that is utilized is rented on a monthly basis. Previously it was a family clinic, but now it is a full-fledged Primary Health Care (PHC) Center. Constraints of the center are:

the small holding area,

they do not have a delivery room (these people are referred to the hospital),

transport problems (to look for defaulters)

and resignations.

The clinic has 8 professional nurses, 1 health promoter and 4 cleaners. The clinic sees about 55 people a day.

Doctors refer patients to Classic House Clinic, with the result that many people are coming in and leaving (this with regard to migrants).

People coming to the clinic are from different areas, because the clinic is in town. The Center is not open 24 hours. There are no volunteers only health workers and the center is not as well organized and formed as clinics in other areas, but Life Line assists very well. There are cases where patients abuse the system. Not every clinic has a computer and most or all of the work has to be captured manually.
Challenges:

The size of the building is a major constraint for the number of services that the clinic is rendering.

The clinic does not have a delivery room and they have to refer patients to the hospital

Migration of patients, especially Tuberculosis (TB)

When the clinic inform patients that they are "sick" e.g. HIV and AIDS, they do not believe the nurses and from there go to another clinic hoping that the other clinic will tell them differently.

Resignations of staff members

Because the clinic is centralized and the fact that doctors refer patients to the clinic the number of people coming to the clinic are increasing.

There are no volunteers to assist with the workload at the clinic, the reason being that the clinic are not as well formed and organized as other clinics in other areas.

Many of the people making use of the clinic are not from the area.

Data is still being captured manually.

Recommendations:

A study will have to be commissioned why patients move around.

Nurses have to explain to patients why it is important to complete the full cycle of their treatment.

The clinic has to look at various mechanisms to retain staff at the clinic.

To link with other clinics in order to be better organized.

Rustenburg Provincial Hospital

Services rendered at Rustenburg Provincial Hospital are:

Tuberculosis (TB)

Anti-Retroviral Treatment (ARV)

Voluntary Counselling and Treatment (VCT)

Nutrition

Prevention of Mother-To-Child Treatment (PMTCT)

Termination of Pregnancy (TOP)

The following observations were made:

At Rustenburg Provincial Hospital they make use of volunteers.

There are 5 lay councilors who were trained by Lifeline.

There is a need in Rustenburg for another Level 1 Hospital.

There is a shortage of beds because of the number of patients.

Rustenburg receives 120 patients a day and 80 patients per night.

Moses Kotane Local Municipality

Social Services in the region

Social Development Service Delivery - Social Assistance/Security

This programme deals with administration of social grants, applications and payments. CPS (Cash Paymaster Service), Banks and the Post Office are companies that have been granted tenders to assist in the process of social grant payments and service level agreements have been signed with them.

Types of grants includes: Old Age, War Veteran, Disability, Care Dependency, Foster Care grant, Child support, Grant in Aid. Types of disability grant include: Temporary disability, Permanent disability.
Projects:

An outreach programme has been established which refers to applications by community members at their respective places/areas, where the official travels to the areas for processing of applications

Pay point development:

The Department of Social Development is in partnership with district and Local Municipalities. Officials at pay points have cell phones and laptops, budgeted for by the Department for easy communication in case of enquiries. More than 10000 chairs have been distributed to different areas as per identified needs. The Department contracted a Service Provider, Mr T, where this service provider is to supply tents to areas where there are no structures. The Department undertook an investigation to different pay points to ascertain which pay points needed the resources.

Development and Support/Community Development

Projects supported here are meant for Poverty Alleviation

National Food Emergency Scheme

More than 3000 households received food parcels (3 times) during the financial year of 2003/04. The number for 2004/05 has decreased to 1000. Those qualifying for Social grants are referred to social security for applications and others to social work programmes.

Proposed projects for funding

Child and Family Care: This project was initiated by the area social workers in 2003. The project started as a result of high incidents of child abuse. Other forms of crimes as described by SAPS are, broken/disorganized families, also aggravated incidents. Achievements of the project: 18 Volunteers trained on the model, secured project site from tribal office, supervising social worker activities, the project serves as referral source for social workers.

Crime Prevention, Rehabilitation: The Center is in operation and offers services to victims of crime/domestic violence. Offers overnight accommodation, counseling and tries to reinstate clients into their families. A nurse from the Department of Health has been seconded to the Center. Volunteers are trained on counselling.

Special needs programmes- Day care center for older persons. Older persons in their respective villages started service clubs as a way to keep them busy and these service clubs do offer home based care services.

People with disabilities- there is a need for workshop /shelter for such groups.

Support group- program for disabled children whereby mothers of such children are grouped together to give each other support on how to cope with their children.
The question was asked whether Magistrates could assist each other in the Bojanala District.

Further comments from the Department:

Food Security: With regard to the numbers it was indicated by the provincial office and the local office do not have any insight or way to influence the process. The reason for the decrease was because of finances. People on Food Security should be linked to other projects, e.g. Department of Health, Department of Agriculture, because parcels are only given for 3 months.

Poverty Alleviation Project: There are currently more than 20 projects. The Department is monitoring the projects, but due to a lack of project managers and financial managers some of these projects collapsed in the past. The result of this is that currently project managers are receiving training.

Disability Grant: The applicant is informed about his/her renewal 3 months before the date of his/her benefits expires. This letter indicates when the beneficiary should apply for renewal. The panel refers cases to the Department of Home Affairs where documents are lacking.

Trial -awaiting children: The only secure care facility is in Brits and the facility is overcrowded. The district does not have such a facility.

Child Headed families: If the eldest is older than 16 and he /she has an identity document then he/she will be responsible for the family.

Foster Care: There is a lack of social workers and no Commissioner of Child Welfare. Rustenburg is the only place that has a Commissioner of Child Welfare.

Child labour: There are no known incidents of child labour in the district.

Indigent policy: The Department is working with the Municipality and the municipality refers cases to the Department
Old Age Home: There is no old age home. Refer elderly to other areas where there are facilities. The elderly do not favour old age homes.
Challenges:

Problems that have been encountered is that there is no office accommodation or building structures at some villages e.g. have to sit under trees, or in school principal’s office.

The main problem is that these programmes are not sustainable. With regard to one project, Success Community Project, which received R250000 from the National Department of Social Development (DSD) (2002/03), where they make cleaning aids, clothes etc. in the beginning there were 100 woman and today only 20 remain. The problems are that people working here do not receive a stipend and they do not have a market to sell their products. The Poultry Farming Project (received R240000 in 2002/03 from DSD) and they too do not have a market to sell their product and they have marketing problems.

With regard to Crime Prevention, rehabilitation challenges include the poor involvement of other stakeholders, need for proper accommodation, no stipend for volunteers and the lack of funds.

A secure facility for Trial – Awaiting Children, since there is none in the district.

The Committee expressed concern that figures for food parcels are arbitrarily decided by the provincial office and that the local office had no input.
Recommendations:

The identified beneficiaries have to be linked with other resources for sustainability, e.g. Public Works Programmes, Department of Agriculture and become members of income generating projects in the community at large.

Foster application- The Committee expressed concern about foster care placements and stated that it should receive priority. The region is experiencing backlogs due to: impact of HIV and AIDS, social workers leaving due to finances. There is no Commissioner of Child Welfare. There is no magistrate to deal with foster care placement to give court orders to process foster care applications. A recommendation has been made that a request be made to the Department of Justice to provide a magistrate to deal with this issue.

Department of Health - Moses Kotane Health Sub-District:

The sub-district is serving a population of 256,869

There are 51 clinics (fixed structures), 17 of these clinics provide 24 hour service

Staffing compliment of 591 staff

No. of villages: 109

Mobile points: 33

It is housed in a shopping complex and it is difficult to control staff. Assistance has been asked for but nothing happened.
Mogwase Health Centre:

Serving a population of 40000, and the informal settlement is 50000 people.

It is a 24 hour service and provides the Core package: laboratory, oral health.

There is 1 full time doctor, 1 mobile unit.

It is well staffed because it is situated mainly urban area.

Mogwase is the only health center performing TOP in this area.

Security is outsourced and generally there is little problems regarding security.

Mogwase is included in the Revitalization programme.

The budget of the center is R44 million and they have overspent and the bulk of the budget went for personnel.

With regard to the infrastructure of the center they had problems with the space. They cannot do the TB test so they have to refer to hospital.

Use to have ambulance but it moved to EMS at George Stegman and this process is not very efficient.

There is a small prefab Hospice and hopefully it will be extended.
Challenges:

Staff shortage for relief especially in clinics manned by 1 professional nurse.

Insufficient budget for maintenance.

Shortage of doctors to visit clinics.

Long waiting time for ambulances (3 hrs) in the radius of 100 km.

HIV and AIDS in the workplace. Losing staff due to the pandemic.
Recommendations:

Staff establishment needs to be revised.

Medium Term Expenditure Framework to be adhered to when allocations are made.

More doctors to be recruited for the rural areas.

1 ambulance to be allocated for each health center.

Staff to be educated to disclose in order to receive treatment, care and support.

Recommendation is made that to ensure that all health centers have back-up ambulances must take care of P2 and P3 cases.
Further Comments:

A number of nurses have been trained in Primary Health Care. They have been trained to train other nurses at clinics.

P3 – chronic cases, P2 – maternity and clinic cases, P1 – accidents/road accidents/fires.

Overspending: - the hospital overspent by 20 % and the district and the center assist each other. There is a budget for a new hospital in Moses Kotane.

Shortage of drugs: - there is a central Medical Store. The supplier does not always supply enough medication.

Two- roomed structure: - this is a health post, it can refer, can give advice and is manned by community health worker and this is to improve access. The mobile visits once a week.

There is no money to train NGO’s .
Tour of Mogwase Health Centre:

Dispensary

Order from hospital.

Sometimes problems with medicines.

100 patients a day.

The room is very small for a pharmacy.

Do stocktaking twice a month.

Laboratory

2 computers in the room.

3 staff members working in the lab.

Waiting time is between 2 – 3 hours.

Major tests done in hospital.

Counseling room

2 professional nurses on duty for TOP (trained).

Dental

1 Dental Therapist working with 1 dental assistant since August 2004 (supposed to be 2) not open over weekend.

Administration Staff section

Using 1 computer and one printer.

5 people have to share computer and printer.

Maternity

There are 11 beds and 2 delivery beds.

They see about 20 people per month.

Do deliveries 24 hours.

Do own laundry in washing machines, because there is no laundry service.

No curtains to divide beds in post labour rooms.

PMCT

More exclusive breastfeeding, baby friendly initiative

X-ray room

Not operational

Refer to George Stegman (15 km away)

Front desk

Patients Right Charter displayed and condoms displayed as well.

Service standards and statistics on service delivery displayed.

Suggestion boxes available.

HIV/Aids information and pamphlets available.

Only center with fixed doctor and they have outreach programmes, but due to shortages it is difficult.

Success Community Project

Success Community Project received R350 000 in the 2002/3 financial year from the National Department of Social Development for their start-up. At Success they are currently busy with sewing and the manufacturing of chemicals. The sewing started in March 2004 and these include, school uniforms, tracksuits etc. The project was established to create employment for 100 people; currently there are less than 20 people. A major problem of the project is that there is no market for these products, both sewing and chemicals. The question was asked whether or not a feasibility study was made before investing in the project? Many institutions were approached to whom these products could be sold e.g. the mines, Sun City and the municipality. Success is registered as a Non-profit Organisation (NPO), but a recommendation was made that they change to a Close Corporation (CC) or a business. The products that are manufactured are SABS approved. The chemicals manufactured are not labelled, the reason being that it is too costly.

Institutions like Sun City and the SAPS promised to buy some of the products, but failed to do so. The Municipality are not buying any of the products either. Being an NPO has its disadvantages e.g. when you apply for work you need a SA Revenue Services registration number.
Challenges:

There is no market to sell these products.

People work for 2 – 3 months without any of the products going out (sold). This is the reason why people leave the project in the hope of finding something where they can get an income.
Recommendations:

The Regional Department of Social Development must assist with the marketing of the products.

Other provincial departments must assist in the process, e.g. Public Works, Education, Agriculture etc.

Government invested money in the project and it has an obligation to assist in ensuring that the project is sustainable.

Saulspoort Pay Point

The Select Committee on Social Services visited the Saulspoort pay point. On the day of the visit the pensioners were receiving their benefits.

At Saulspoort there are adequate shading (big tent) and chairs.

The pay point is fenced (only the people (beneficiaries) are within the boundary)

There is a presence of armed guards and they are visible.

Hawkers are behind the fence, and they are at an adequate distance from the pay point.

There are several water taps that are visible and in working condition and 4 mobile toilets.

Umzansi was present at the day of the payment, and there were conflict between Umzanzi officials and officials of CPS. The conflict related to the fact that Umzanzi was within the boundary of the fence and conducting their business with the beneficiaries. A recommendation was made that Umzansi set up their operations outside of the fence.

George Stegman Hospital

Overview- Presentation done by CEO of Hospital:
Two Nursing Manager posts are to be filled before the end of the month and one Clinical Manager post to be advertised.

The physical infrastructure of the building creates problems because the structure is already 60 years old. Lots of the services will be outsourced in the future e.g. laundry.
George Stegman is not yet accredited, but it will be once they move into their new building. The hospital wants to keep the houses on the current site for accommodation. The hospital did not have a maintenance plan, but a plan is now in place.

With regard to TOP the hospital are experiencing problems. The drug used for TOP was not available in the hospital, due to a communication problem with the distribution thereof to the hospital. The hospital has thus far referred patients to Rustenburg.

The hospital has recruited staff from Moreteletsi to fill the vacancies and these staff members are to start the 1^st of March 2005. According to the CEO the finances are managed well.

The State Accountant is responsible for the finances of the hospital. The management of the hospital have regular meetings to review the expenditure and needs of the hospital.
Challenges:

Maintenance- the maintenance of the hospital, especially e.g. mortuary fridges often not working, stand-by generator.

Revenue collection- the hospital are under-collecting revenue due to perception amongst locals that it is their hospital and that they do not need to pay and this is a strain on resources.

Health professionals- there are 64 professional nurses on the establishment and all posts are filled, however the closure of Moreteletsi hospital increased the workload of George Stegman.

21 posts approved for medical officers, but only 14 filled of which 6 are community service doctors. The hospital is unable to retain doctors after they have completed their community service.

Allied Health professionals- the hospital does not have permanent staff, only community service staff.

Accommodation: the hospital are experiencing accommodation problems for staff members.

Medication- there is a shortage of medication, due to a lack of funding.

Response from Management:
The budget for 2004/5 was R36 million, and other than personnel and drugs, the entire budget was depleted by October 2004.

Hospital Board- there used to be a Hospital Board, but it was dissolved by the MEC in July/ August 2004. A new submission has been made for a new Board and the MEC indicated that it would be approved.

The hospital established a Complaints Committee to see to complaints.

Moreteletsi closed down because the physical structure was collapsing, because of the soil quality and the water supply also dried up.

With regard to the staff establishment there is not considerable vacancies. In the management 2 posts are filled and 2 vacant, professional nurses are all filled, administrative staff 2 posts vacant.

The recruitment of doctors is a major problem. The accommodation for doctors who has families is a problem; there is no accommodation for them. The doctors also claim that the rural allowance is not sufficient.

Synchronizing the management structure of the two hospitals, resulted in one management structure
Visit of George Stegman Hospital:

There are not sufficient shelves in the mortuary.

6% of patients die in hospital of HIV and AIDS.

The hospital got a quotation for fixing the road of the hospital.

There is a maintenance budget at regional, but it is centralized.

In the OPD there are 323 active beds.

Visual Management of Batho Pele principles are present in the hospital.

The hospital sees between 120 – 200 patients a day in the casualty ward.

The procedure with regard to acute patients is not up to standard. The acute patients are suppose to stay for only 72 hours, but some of these patients stay for much longer and this is not conducive since there are only 5 beds. If the patient remains acute for longer than 72 hours they must be sent to the psychiatric hospitals.

84 interns will be getting training at the hospital.

In the paediatric ward there is no air - conditioner, and sometimes it is overcrowded, where children have to share beds. The hospital does not have a paediatrician, but there is a general doctor stationed in the ward.

In the laundry, conditions are poor. The machinery is old, and the ceilings and the floor are not in a poor state. There is little stock of pyjamas and linen.

Visit to Odi Hospital

The Committee had a meeting with the senior management and the Regional Director of Health of Odi Hospital on 16 February 2005.

Overview by the CEO of Odi Hospital

Odi Hospital does referrals to Ga-Rankuwa Hospital. At Odi there are 9 doctors, 161 professional nurses, 32 administrative staff and 89 support services staff. The staff establishment is 97%. After 4pm there are no OPD (Out Patients Department) and patients are referred to the casualty ward. There are 198 active beds at Odi Hospital.
Comments from Management

The hospital does have PHC, Maternity, Eye care; HIV and AIDS clinic and a psychology unit The Budget for 04/05 was less than what was allocated. The reason for this is that the hospital is spending money that they do not have.

With regard to complaints by patients there is a book at the registration where patients can write their complaints in. It is management’s job to communicate with complainants and they should report within 3 days after receiving complaints. There are also suggestion boxes in the hospital. The issue of the Hospital Board is that the Board disbanded in November 2004. Names of new nominees have been submitted. The role of the board will be to ensure that new government structures are in place. The response from Councillors has not been good in assisting with this process. The Board is there to support and advise the hospital and community and to make reports and follow-up.

In order for ARV to be rolled out, the hospital needs to be accredited and nurses will have to be trained with regard to the rollout of ARV.

Because of the number of fridges broken down in the mortuary, the hospital has a relationship with private Funeral Burial companies to relieve some of the load of the hospital. These undertakers are: Gift Neo Undertakers, Bambi’s funeral and Bennies funeral.
Visit of Odi Hospital:

Patient Registration

There are directions at the Patient Registration to indicate to clients where they should go for which services, but there is no Charter of the Rights of Patients.

Dispensary

The dispensary is under lock and key. This is where medicines are issued to patients. The pharmacist indicated that there is no shortage of the supply of medicines. Intensive stocktaking takes place twice a year. There are medicines available in casualty for after hour’s patients if the dispensary is closed (dispensary not 24 hours). SMME’s assists the hospital to distribute pharmaceuticals to clinics.
Casualty Ward

In the casualty ward there is a consultation room, but there is not much privacy. During weekdays the casualty ward is not that busy. The casualty ward has 1 full time doctor and the hospital has 3 radiographers.

Mortuary

At the mortuary there are 5 fridges with 3 shelves each (15 in total) but 9 out of 15 does not work. The hospital gets assistance from private mortuaries.

Pest Control

The pest control is a major problem, the reason being that management questions the efficiency of the pest control that the company uses.
Challenges:

The budget of Odi is a challenge (never sufficient funds). Personnel and Standard Items are a major challenge. The budget of the hospital was R46 million, but it was adjusted to R38 million. The reason being that for that every year the hospital begins the financial year with a deficit. To cover its operational costs the hospital "needs" R46 million.

Odi cannot retain staff

Doctors are difficult to attract. Some of these doctors only come to gain the experience after which they leave.

Maintenance at Odi is a major problem since the building is 11 years old. The hospital at this stage is only utilizing one boiler, the reason being that the other boiler has been broken for the past 2 years (too costly to repair) and they have a generator in the event that there is no electricity.

With regard to the mortuary their fridges are broken and the cold room was revamped but has broken down after the 1^st month of use.

Security at the hospital is of major concern. The hospital can only afford 4 security staff and they have to secure the complex day and night. The hospital pays security out of the budget of the hospital. There are frequent burglaries and some areas of the complex are not protected.

In the kitchen there are problems with fridges that have broken down.

In the laundry the big machines break and need to be fixed but the hospital cannot afford to repair it. The linen in the hospital is not of a good quality.

The air conditioner cannot carry the load.

Because of the cross-boundary the hospital the have to carry costs.

Revenue: people believe they do not have to pay for services rendered.

The HIV and AIDS clinic is for preventative and promotitive purposes and there is no ARV rollout because it is not yet accredited.

Visit Dolly Rathebe Old Age Home

Overview of Center:

The Centre is being used as a crèche and a pay point for Social Grants. The National Department of Social Development is funding the building. The Local Office of Social Development has not worked well with the center. The center receives funding from: the French Embassy and the Department of Social Development. The center was mainly established for: poverty alleviation, a soup kitchen and free food to the old aged.

In one of the rooms the old aged are sewing and this is all done by hand, since there are no sewing machines. The products are sold at various social grant pay points. Progress is being made on the building of a new crèche and funding received from the French Embassy is utilized for the building.
Recommendations:

That the Center must be able to work with other private stakeholders e.g. BMW, Nissan etc

That there must be Council involvement and that the Regional Department of Social Development must be part of the process. They have to arrange a meeting with the ward councillor and the Regional Department of Social development to establish a committee to take the Center forward.

With the building of a 2 roomed structure to work in conjunction with the Department of Health.

Visit of Disability Center

The National Department of Social Development subsidizes the Centre.

The Centre caters for all ages, and the Centre does the rehabilitation.

The Centre is 40 years old and is housed in a four-roomed house. There are currently 73 disabled persons and it is overcrowded.

The Centre is registered as a Non- Profit Organization

The Centre does skills training and ABET literacy, however they only do mainstream curriculum, but they are negotiating for ELSEN.

Every person at the Centre receives a disability grant.

Transport at the Centre is a major problem, the reason being that there is only one combi to transport disabled members.

The subsidy (R3000) that the Centre receives from the Department of Social Development is not sufficient for the day-to-day operations and needs to be increased.

The empty building across the road belongs to Social Development and it has been requested that the Disability Centre utilize the building (there is more space). A recommendation was made that the Provincial Portfolio Committee needs to take up the issue of the building.

The mobile clinic comes around once a month to the clinic.

There is doctor and he gives his services free of charge.

There are 11 staff members: the 5 subsidized by the Department of Education and the Department of Social Development subsidizes 6 of the staff.

Challenges:

Subsidy received from Department of Social Development not sufficient

Transport is a major problem, because the vehicle is giving mechanical problems.

The building structure currently in use is insufficient.
Recommendation:

To get assistance from Provincial Department of Social Services.

Visit to Itireleng Workshop for the Blind

In the workshop there are 188 people.

70 receive monthly payment and the rest weekly.

There is a boiler in the workshop and it is in an excellent condition.

People working at the Centre live in the hostels and some in the zone location.

The able persons makes the frames.

Products are sold to the community and to government departments

The people working at the Centre are from different areas and provinces.

The Department of Social Development runs the funding of the Centre.

Most of the instructors are abled persons

The Center is made up of 4 subsections.

In the knitting and sewing section they had to train people to train others.

There is a pre-school on the premises for the children of the people working at the Center.
Challenges:

The lack of proper staffing.

The sustainability- the revenue collected is not ploughed back into the institution.

Marketing- the institution has to compete in an open labour market.

The inmates at the have over time become employees of the state. No institutional Governing policies on weekly vs. monthly paid staff.

Bojanala District Municipality- Department of Health:

Issues that had to be followed up on:

Whether the Strategic goals of the Municipality are linked to the Ten Point Plan of the Department of Health: The municipality will attend to this area, and the matter has been referred to them.

Report regarding the high turnover of doctors and nurses: This is a national problem, and our Bojanala region is no exception. A major problem in the region is that they lose these cadres to other provinces such as Gauteng and Limpopo. The department has a strategy on the recruitment and retention of health professionals. With the advent of the community service for nurses the region hopes they will continue receiving a good number. In the areas where the problem is caused by the lack of posts, the department is in the process of finalizing the staff establishment, which will address this area.

Number of doctors available – permanent doctors and community health doctors: There is a total of 81 doctors including both the interns and the community service doctors, and these doctors cover the 5 hospitals and the clinics as well as the community health centres (There is a total of 1244 beds in the hospitals and 138 clinics including health centres)

Report on Pharmaceutical issues: The delivery of medication to clinics (outsourced): The SMME have been contracted to deliver the medications to the clinics and the Community Health Centres, so much that there is no longer a problem of shortage of medications in the clinics, except in the case where there is a general shortage in the province, in which case the central medical stores assists in addressing the problems.

Short summarized report regarding shortage of ambulances: The department is in the process of procuring the new fleet of ambulances to replace the ones that are repeatedly breaking down because of the bad road conditions, and the heavy workload. Bojanala will also benefit from the process of procurement of the ambulances after which the situation will improve.

List of NGO’s funded by government: The process of separating the NGO’s that are funded by the department and those funded by other departments is still being finalized through the social cluster. This is made worse by the fact that there is a lot of cross subsidization and as such the region need to have those that are funded for the health programmes only.

Report regarding Traditional Healers in the district. What is the situation?: The department has a sound relationship with the traditional healers in the management, care and support of those patients that are suffering from debilitating diseases such as TB, AIDS, Pneumonia etc. The regional Health Department meets with the traditional healers at the level of District and Local Aids Councils, which is where the planning, coordination of the intersectoral activities towards the management, care and support on the HIV and AIDS is being deliberated. Together with these colleagues the region serves in the District Steering committee that is aimed at preparing and monitoring the implementation of the comprehensive plan on the roll out of the Anti-Retroviral Treatment programmes, and it is chaired by the Chief Executive Officer of Rustenburg Provincial Hospital.

What is being done to attain the assistance of private sector ambulances? There are very few private ambulances in this area, especially due to the rural nature of the district, and these are only available in Rustenburg, and they get called in the event of the major incidents/accidents that require life support.

Devolution of powers- patients bypass clinics and go straight to hospital: The devolution of powers is the competency of the Provincial head office, and as such the region only act as and when directed and guided by the relevant proclamations and policy directives; Regarding the patients that go directly to the hospital, the problems is caused by the fact that there is no district hospital in Rustenburg, with a population of 395 000 people. Because of the mentality that the service is better at the hospital, there is very little the Department can do to stop the patients, but the gateway clinic that is there at the gate of the hospital is meant to address this problems minimally though as it is to small. The appointment of the Family Physician who has just started working in the region and is doing a lot of work in the hospital will assist in addressing the problems of the non specialist cases that walk directly into the hospital.
CTOP:

Number of professional nurses involved in CTOP: There are a total of 22 nurses that have been trained in CTOP in various institutions.

Is there a decline in back-street abortions? There is a decline in the back street abortions, as a result of the access to the TOP services, though the teenage pregnancy is still on the rise even for those that are coming for the second time for the TOP services.

Disposals/incinerators is there a Waste management programme in place with respect to CTOP: The department has a waste management programme that has been outsourced to the Millennium Company. This company collects all medical wastes inclusive of those generated through the provision of the TOP services. The incinerators that were installed in the clinics were not designed to incinerate the human tissues, and due to lack of proper explanation at the time of installation, people thought they were for that reason, and it is only now that those that have been installed are used, and problems are minimized.

Number of persons returning for results of HIV/Aids testing? The percentage of the persons that return for their result is very low @ 35% in all the clinics where testing is done instantly, and this is attributable to the fact that there is still a stigma, in spite of the counseling that is being done; the project of improving this is done in collaboration with the District Aids Council, and it is hoped that through social mobilization, the percentage will increase; it is only in the cases of voluntary counseling and testing that the results are available on the spot, and in this case it is 100%.

Process of monitoring PMTCT Programme? This programme is monitored as part of the mother Child and Women’s health in the facilities that are rendering the services, which are mostly those that are rendering 24 hours of services. There is however some difficulty in doing a complete monitoring as some of the mothers who enrol for the programme at the clinics and health centres do not come back to deliver at our facilities. Most of these mothers deliver at the private hospitals, some at the public hospitals. All of the district hospitals are running the programme on the PMTCT, but it becomes difficult for the stats to be realigned with that of the clinics, as unless the patient discloses, the nurses may not know, or may start the process all over afresh.

Odi Hospital:

Formal report of lawsuit against the Premier: This matter has been put to the formal investigation by the duly appointed investigating officers, in the name of Ms. K Taoana (Premier’s Office) and Dr Mphake (General Manager for Brits hospital). Given the complexity of the problem and the fact that it includes George Mukhari hospital, which is in Gauteng, The colleagues have not finalized the process but they are still busy and the information will be furnished at the right time. These colleagues will give the report to the office of the premier, so much that this office may not know the progress made until the office of the Premier shall have received the report.

Annual Report and latest Quarterly Report: The annual report will only be available late this month of April, and we are of the opinion that in the mean time we should give the report of the last quarter of the calendar year which report was submitted in January 2005, and it shall be marked the third quarter report.
Mogwase Health Center:

Details on progress regarding Revitalization program: The tender has not been advertised as yet and the municipality has already allocated the site next to the Health Centre, and this site will be used for the construction of the centre. The Directorate in Head Office responsible for the capital/ physical structures handles this process.

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 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.