DRAFT REPORT ON THE OVERSIGHT VISIT OF THE SELECT COMMITTEE ON SOCIAL
SERVICES TO THE WESTERN CAPE PROVINCE 31 JULY - 04 AUGUST 2006
Introduction
The Select Committee on Social Services undertook a study tour to the Western
Cape Province from 31 July - 04 August 2006. 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 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 2006/07 financial year and the Committee identified the Western Cape
Province as a priority.
The regions identified by the Committee were: the Cape Metropole, Worcester,
Oudtshoorn and George.
The information was gained by interacting with the MEC's, HOD's 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).
Limitations of the report:
·
The fact that not the whole of the Western Cape Province could not be
visited, but only parts of it.
·
The Committee was unable to visit Oudtshoorn, as was scheduled, due to
roads beings closed due to floods
Social Development
1.1. Meeting with the MEC: Ms Mqulwana
The MEC stated that it is a challenge for the department to separate the SA
Social Security (SASSA) from the Provincial Department of Social Development,
but in saying this at the same time both SASSA and Provincial Department of
Social Development (PDSD) must ensure that beneficiaries get good quality
service delivery.
The MEC noted that in the department there is a lack of transformation and this
relates to a lack of redistribution of resources, equity etc. where example in
Khayelitsha 1 social worker is serving 17000 people. The MEC noted that a task
team has been established to look at transformation in the department.
The MEC said that 25% of the budget has been set aside to establish
organisations where there were none previously. She further noted that the bureaucracy
is hampering service delivery. The MEC informed the Committee that the
Department has changed its name to the Department of Social Development
(previously Department of Social Services and Poverty Alleviation).
The MEC stated that women lead 80% of the projects funded by the department.
1.2. Briefing by the Department of Social Development
The HOD briefed the Committee on the strategic goals and the budget structure
of the Department.
On the issue of children in correctional facilities in the Western Cape, the
HOD stated that on average there are 2200 arrests per month. She further noted
that the department as part of an intervention strategy set a benchmark of 150
children in correctional facilities in the province. It was stated that there are
142 children in prisons awaiting trial and that 86 of these children are in
Pollsmoor Prison. The Department informed the Committee that additional
probation officers were employed to assist and that an interdepartmental task
team has been set up to streamline procedures.
With regard to the management of children the Department stated that every
child is assessed by a probation officer within 12 hours of arrest and that
follow-ups is done on children in correctional centres for placement at
suitable alternatives and that there are monthly reviews on cases of children
awaiting trial.
Challenges that are faced by the department concerning Child Headed Households
are that census information is not helpful in identifying the extent of the
problem. The department further noted that the Draft Children's Amendment Bill
2006 addresses Child Headed Households and sees a child over the age of 15 as a
head of a household, and that this is in conflict with other legislation that
specifies that to qualify as a foster parent you must be 18 years and older.
Another challenge is that organisations do not provide details of child-headed
households but rather orphaned and vulnerable children, and that internal
statistics reflect children in foster or alternative care and not as a
household head. A challenge for the department is that children who are living
on their own might not know how to access support services and in some
instances children fear being removed from the environment they know. The
department stated that preliminary costing of the implementation of the
Children's Bill indicate that at least 52% of funds to implement will be spent
on orphaned children as a result of HIV/AIDS.
The department stated that in the absence of reliable data the departmental
focus has been orphaned and vulnerable children that includes child headed
households. The department further noted that foster care placement is one of
the options exercised to address the needs of orphans and that the department
currently funds 18 shelters for children that accommodates approximately 387
children in the province and that 181 NGO's, CBO's and FBO's are funded that
work exclusively with families and children including HIV / AIDS and partners
include the departments of Health, Education and Local Government. Much
emphasis will be placed on family strengthening programmes in the province that
will focus on the care of vulnerable children through building the capacity of
communities and families.
1.3. Clarity seeking, comments and questions
With regard to substance abuse in the province, with reference to
"Tik", the MEC stated that 1000 young people have been recruited to
assist the department in this regard.
The MEC stated that with regard to ECD the department is taking the lead in
grade R and the department of Education is assisting with the curricula, but
that there is a close working relationship with the departments of Education
and Health.
The department worked with the Unicity regarding street children and last year
the department gave R2 million for this project.
On the issue of soup kitchens the HOD stated that the cut-off time for soup
kitchens is 6 months, the reason being that the department do not foster
"dependency".
1.4. Visit to Sarepta Home for Older Persons
1.4.1. Introduction and background
The manager of the facility, Ms La Poorta briefed the delegation and stated the
following: The facility is registered to accommodate 150 frail and aged persons
and falls under the auspices of the Apostolic Faith Mission Church's Welfare
Commission. The board and management have transformed and is representative of
the demographics of the Western Cape. The facility is situated in a
predominantly coloured residential area and enjoys the support of the local
community. The current manager has been in the position for several years.
The facility has a staff component of 52 consisting of 33 nursing staff, 16
general workers, 1 administrative officer, 1 secretary and 1 manager
The residents come from all areas (metro and peri-urban) and not only from the.
Kuilsriver community, and currently there are 146 residents consisting of 81
women and 64 men with 81 % of the residents being frail.
The facility manager stated that all the grant payments of residents are paid
to the facility, this translates to R840,00 X 146 residents. Other sources of
financial income is obtained from donations, bequeaths and fund-raising events.
The state subsidy is the largest financial support to the facility. The total
subsidy transferred to the facility for the period April '05 - March '06
totalled R1, 923525.00.
The manager informed the delegation that the regional office (Eerste River
District Office) the facility complied with requirements and the residents
seemed contented and happy.
The following challenges exist at the facility:
·
Except for administrative staff members, the provision of both the
nursing staff and the kitchen are outsourced.
·
In the past the department received numerous complaints about the care of
the residents, and according to the manager, outsourcing these services
improved the service at the facility.
The delegation enquired whether the facility has a well functioning
board. The manager stated that the Board consists of 7 people (2 residents and
5 from the community) and that it is functioning.
The manager informed the delegation that of the residents that do not have
family members and that even those that do have, do not come to visit them
regularly. She further noted that the institution buys the residents clothes on
special occasions, and that they look after the residents everyday needs.
The delegation enquired what happens to those "residents" who are
unable to pay for their burial, and the manager replied that family and friends
are asked to assist in this regard and if they are unable to, then the
institution will pay the undertaker for the service who charges the institution
a special rate.
With regard to residents visiting their family members, the delegation enquired
what is being done by the institution to assist in this regard. The manager
stated that some of the resident's family members come to pick them up, but in
the event that family members do not have transport to fetch them (the
institution does have a combi for home visits), the institution takes them to
their family members and collect them again.
The delegation asked whether or not a well functioning Committee for the
residents exist at the institution? The manager stated that many of the
residents is mentally incapacitated and because of this that the Committee
lapsed.
In conclusion the delegation raised concern regarding the terrible conditions
under which the residents are living in the facility. As the delegation for
example toured the facility they found that the blankets, which the residents
are sleeping under, are tattered and ragged. The delegation visited the
facility during the afternoon and it was cold, but in the "entertainment
area" there were no heaters, the reason being that residents there were
getting cold.
1.4.2. Recommendations
·
That the institution need to explore best practices in e.g. Northern Cape
where Old Age Homes pays fees to AVBOB for burial services.
·
That the institution can play a greater role with regard to home visits.
·
That follow-up visits be made to the Old Age Home.
2.
HEALTH
2.1. Meeting with the MEC of Health: Mr P Uys
The MEC stated that 70% of the 4,2 million people in the Western Cape do not
have medical insurance and that many people come for Primary Health Care (PHC).
He further noted that Tuberculosis is very high in the province, but in saying
this the Western Cape has one of the highest cure rates of all the provinces in
the country; and he further stated that chronic diseases is also on the
increase in the province e.g. diabetes, asthma etc.
The MEC informed the Committee that there is a major demand for facilities
especially PHC, due to the influx of people, from various provinces, to the
Western Cape.
2.2. Briefing by the Department of Health
The department stated that the Comprehensive Plan for HIV/AIDS in the province
was to ensure that those citizens who are not infected, remain uninfected; and
to enhance efforts in prophylaxis and treatment of opportunistic infections and
to improve nutrient and lifestyle choices; as well as the effective management
of HIV infected people who have developed AIDS.
With regard to Voluntary Counseling and Testing (VCT) the department stated
that pre-and post counseling is being done and if found that a person is
positive, he/she will be referred to appropriate medical care and if negative
to re-enforce safe sexual behaviour. VCT is available at all 446 health
facility sites and 373 lay counselors are employed via 23 NGO's. Results of VCT
in province include: 283 834 persons older than 15 years counseled and 262 792
person's older than 15 years tested for HN/AIDS.
The department stated that the there are 43 operational sites and 16 343
clients on treatment for Antiretroviral (ARV) Treatment Programme (2005/06) and
the target for 2006/07 is 50 operational sites and 22 489 clients on treatment.
The department informed the Committee that at the end of June 06 there were 18
941 patients on treatment.
Progress with regards to Community Home Base Care (CHBC) is that during 2005/06
10 220 HBC clients was seen and of these 1871 were HIV clients, 857 TB
clients and 187 TB/HIV. The department stated that 1630 carers were being
trained on part qualification of the NQF level 1 of the National Auxiliary
Health Worker Certificate.
The department stated that some of its major challenges include: the integration/mainstreaming
of the Comprehensive Plan in the District Health System (DHS); the
prevention/promotion of the behavioural change of clients and staff; and the
case load in the "high prevalence areas", due to migration.
In conclusion the department stated that the implementation of the
comprehensive plan is progressing well; the HBC programme will be expanding
rapidly; PMTCT programme has excellent outcomes; and the VCT programme is
progressing well.
The department further briefed the Committee on the Hospital Revitalisation
Programme in the Western Cape and quality assurance.
2.3. Clarity seeking, comments and questions
The department stated that they do train doctors and that there is a need to
re-Iook the policy on those staff who took severance packages, since many have
left and that the salary levels of nurses have to be looked at. The department
said that six (6) nursing schools are providing in service training, which is
taking place at the facility and the department reiterated that the number of
nursing schools has to increase.
The department noted that a site has been identified in the Khayelitsha area,
but the delay is now with the City.
Members raised concern on the issue of Emergency Medical Services (EMS) and the
department stated that they are working on this and that a budget of R230
million has been set-aside for this purpose. The MEC also noted that many
volunteers are assisting in this programme.
With regard to infrastructure the department stated that they had problems
(e.g. R15 million which was underspent), but they noted that the current budget
ofR149 million would be spent.
The department stated that TOP is performed and that there is staff rendering
this service, but the department's main concern is the young girls coming
repeatedly.
2.4. Recommendations
·
That the Committee take up the issue of nursing schools to the National
Minister and the National Department of Health.
·
That the Committee allocate sufficient time for meetings with MEC's and
the departments
2.5. VISIT TO GUGULETHU KTC DAY HOSPITAL
2.5.1. Introduction
The Facility Manager stated that the hospital provides Comprehensive Primary
Health Care service and that they see patients with minor ailments who are
referred from other centers. The hospital has 24 Registered nurses and 8
doctors and it is operational over weekends and public holidays. There is a
psychologist at the hospital.
The hospital sees chronic patients e.g. diabetes, cardiac, asthma, epilepsy
etc.
Currently the hospital provides for first level of TB, but they are in the
process of rolling it out comprehensively. The monthly intake of TB patients is
50 where they test to identify whether the patients have TB and if so they
refer them to the Gugulethu local clinic.
With regard to school health the Facility Manager said that nurses do visit
schools in the area to educate learners regarding health issues.
2.5.2. Budget of the centre
The budget of the facility is centralised.
2.5.3. Infrastructure
The hospital has been upgraded during the past years, but the facility manager
stated that the community in this area is very destructive, but the hospital
has 4 security guards at the gate and 3 inside the centre. There are leakages
in the roof at the hospital and a requisition has been sent to Head Office for
the repair thereof. There are 8 computers for the development of the staff as
well as for the community.
2.5.4. Challenges
The facility manager informed the Committee that a challenge at the hospital is
to recruit people to work after hours in the trauma unit. Another challenge is
the long delays of EMS.
2.5.5. Clarity seeking, comments and questions
The facility manager stated that the waiting time at the hospital is
problematic and patients at times have to wait for 4 hours.
The facility manager noted that teenage pregnancies is very high and that it is
a problem in the area, and the hospital does not perform Termination of
Pregnancy (TOP), but that they do referrals.
The facility manager informed the Committee that there are various vacant posts
and that there is high vacancy turnover rate at the hospital. There is a full
time social worker at the hospital and on every shift there is a Registered
Nurse in charge and even during the electric blackouts the hospital experienced
minor setbacks, the reason being that there is generator at the hospital.
2.4.6. Recommendation
·
Members stated that the response time for EMS is a worrying factor and
this will be taken up with the National Minister of Health and the Provincial
MEC of Health.
2.5. VISIT TO LANGA WASHINGTON CLINIC
2.5.1. Background
Langa is the oldest "black township" in Cape Town and contains both a
formal and informal settlement. A significant percentage of the population
resides in the informal settlement. This is a highly mobile sector due to both
high rates of urban - rural migration to the former homelands areas of Ciskei
and Transkei in the Eastern Cape and the movement between informal areas within
Cape Town.
The rate of unemployment in the area is high with many inhabitants existing
below the poverty line and the suburb is one of great need with HIV prevalence
and the TB incidence is about 1500/100000.
2.5.2. Infrastructure
Staff at the clinic comprises a facility manager, 2 clinical nurse
practitioners, 6 professional nurses, 2 enrolled nurses, 3 enrolled nurse
assistants, 1 administrative assistant and 4 lay-counsellors.
The facility manager stated that it is envisaged to extend the clinic and that
plans has been approved.
2.5.3. Services rendered
The facility manager informed the Committee that ARV was rolled out in January
2004 and 25% of TB patients are on ARV and that the clinic sees about 800
patients per month for AR V.
The clinic is open from 8am - 16:30pm, but at times it necessitates that staff
comes in earlier because of the TB patients. The clinic has an outstanding cure
rate of TB that is at 89%.
With regard to VCT the clinic received a trophy from the City for their
services rendered. In 2004/05 the head count was 130000 people and in 2005/06
112000. The facility manager stated that they see about 9000 - 14000 people a
month.
2.5.4. Challenges
The facility manager stated that space is a problem at the clinic. There is
also a shortage of clerks for filing, the reason being that files are piling up
for data capturing. EMS is a major problem in the area (especially response
time), because in certain circumstances staff has to drive patients with the
council car to the hospital.
2.5.5. Clarity seeking, comments and questions
The facility manager informed the committee that TB is on the increase in the
area and the clinic does not render antenatal services (there is a clinic close
by) and for ARV there is 1 doctor and 1 doctor for TB who comes in 3 mornings a
week and the other doctor twice a week.
With regard to TOP, whomever needs it comes to the clinic for counseling and
then gets referred to the appropriate facility. The facility manager stated
that many young girls frequently come in for this service (at times - the same
girl- up to 4 times) and a study is currently being done as to why they do not
come for reproductive health. She further noted that even HIV patients do not
want to use condoms.
The facility manager stated that at times the clinic runs out of medicine (at
times for a month), and this is very de-motivating for staff, but the clinic
does not run out of TB medicine and ARV.
The clinic's waiting time is 60 minutes (1 hour), where the patient comes in,
gets a file (every patient has a file), and then waits to be called. There is 1
doctor for two mornings, 1 doctor 5 days all day, 1 doctor 4 days a week (which
is to be changed ŁTom September 2006 to 5 halve days) and 1 doctor Friday
mornings.
2.6. VISIT TO MICHAEL MAPHONGWANA COMMUNITY HEALTH CENTER - KHA YELITSHA
2.6.1. Background
Michael Maphongwana Community Health Centre is based in Harare, Khayelitsha
and it caters for the previously disadvantaged communities, with low
socio-economic status. The facility is rendering all the primary health care
services.
The center sees about. 8 000 to 12 000 patients per month for different medical
reasons. Presently there are 115 staff members from different categories. The
operational budget of the centre amounts to R22m for 2006/07. About 62, 8% of
the budget goes for the remuneration of employees and the remaining 38, 2% is
for goods and services. Operating hours are 07:30 - 16:30 and 24 hours for the
MOU labour ward as well as security personnel.
2.6.2. Clarity seeking, comments and questions
TOP is done by the facility (12 weeks and below) and if 16 weeks then the
patient is referred to GF Jooste and there are people who returns for the
service.
The center manager stated that submissions has been made to expand the facility
with v~ous extensions, but he noted that a district hospital is envisaged to be
build across the facility
It was noted by the management that EMS response time is poor as well as
transport at the hospital itself.
The center sees about 12 000 patients per month and the center manager noted
that Khayalitsha makes up 27% of HIV/AIDS patients in the Western Cape. He
further noted that migration has an affect on the center as well.
The center manager further noted that substance abuse is not really significant
in the area, but that teenage pregnancy is very.
2.7. Visit to Eben Donges Hospital- Worcester
2.7.1. Background
Eben Donges is a regional hospital, and serves the whole Boland Overberg
region. The hospital is currently in a revitalization phase and when completed
in 2008, it will be bigger, with new equipment, and staff trained not only in
their fields but also in new methods of management.
In the new out-patient clinics, patients will be able to different kinds of
doctors, therapists, social workers and counsellors. The trauma centre is open
24 hours a day and no patient needing emergency medical attention are shown
away.
The hospital is one of two hospitals in the Western Cape that is currently
being revitalised by the department of Health. The 33 year-old hospital in
Worcester will see its exterior and interior completely revamped, with
extensive building alterations over the next 4 years. In 2001 three new wards
were built as part of a National Hospital Upgrading project by the Department
of Health. A casualty wing, a new outpatients department and a new training
centre is to be added to the main hospital building.
2.7.2. The Revitalisation project will include:
·
A new Emergency Unit, providing an adequate trauma unit, serving as a
first base for trauma on the N I.9
·
Day Surgery Unit, providing services for procedures required by
out-patients . A kangaroo unit, which will extend the existing capacity to 14
beds.
·
Extension in the Intensive Care Unit to 7 beds, improving on the existing
three bed ICU.
·
An 8 bed Burns Unit
·
A 6 bed Acute Care Centre for Psychiatry patients.
·
A new Human Resource Development section, equipped to serve the training
needs of the entire Boland/Overberg Health region with training focused on
clinical issues.
·
A modern training centre with lecture theatre and classrooms will be
built.
·
A renovated and extended out-patients department.
·
4 operating theatres.
·
Improved site and emergency unit security to ensure the safety of
patients and staff.
2.7.3. Clarity seeking, comments and questions
The
Hospital Superintendent said that TOP is done twice a week for patients under
13 weeks pregnancy. Patients over 1 weeks pregnancy was done at Montagu
Hospital as it was temporarily stopped at this hospital due to a unfortunate
complications. It will resume at this institution as from August 2006. Eighty percent
(80 %) terminations in the region are under 13 weeks. Although few terminations
are repeats, the number is slowly increasing and is a concern. An increased
effort will have to be made to promote contraception.
The Select t committee raised the concern that the staff of the Hospital is
"Old, sick and lazy". The perception might have been raised because
of the focus of this hospital on absenteeism. The unscheduled leave of staff at
this institution is under 3 %, which is very good. All leave, sick leave,
extended sick leave (PILAR) and maternity leave is reported on every month at
the Monitoring & Evaluation meeting.
A contractor removes medical waste 3 times a week. All placentas are bagged and
placed in a freezer until the contractor comes to remove it. No medical waste
is kept in the wards. A new waste management area has been added to the
hospital.
Staff morale is generally good. A staff satisfaction survey is planned for mid
August. A previous Staff satisfaction survey showed that staff morale is good.
Nursing is under some strain due to staff shortages, which might affect staff
morale. The Revitalisation of the hospital is a difficult phase as it is
expected to be fully operational in the middle of a building site. To cope with
this, the hospital has an intensive program for change management.
The Hospital Superintendent informed the delegation that the hospital started
training Auxiliary Nurses 10 years ago when it became apparent that a nursing
crisis was looming. This has been a very rewarding program as hospital train's
people for the local region. Thirty eight percent (38%) of all nurses employed
in the region were trained by this hospital. The hospital has 95 students this
year and train for the adjacent regions as well. Learners in HR and IT are also
accommodated here and they are remunerated according to guidelines from our
Head Office. The hospital hope to be able to employ them at the end of their
learnership.
Under-expenditure on staff: The hospital was given an additional R3,5 million in
the previous financial year to appoint additional specialists. Due to problems
in recruiting specialists 2 were appointed only by July 2005 and the other 3 in
February and March 2006. Specialist posts are expensive and the
under-expenditure of more than R3 Million is due to these posts being vacant
for so long.
Over expenditure on Goods and services: The over-expenditure of R1,3 Million
was incurred when the department gave approval for additional payment of the
blood & laboratory account for March 2006.
The management team has 2 vacancies at his stage: the Assistant Director:
Quality of Care and one nurse manager post. The staff establishment for the new
revitalised hospital is 72% filled.
The hospital is a site for ARV management. The adherence to treatment is good
and the dropout rate is under 2%. Mortality rates are also very low. The
hospital superintendent stated that of the 600 adults over 400 are on
treatment. And of the 117 children, 78 are on treatment.
The time frame for completion of the revitalized program is end of 2007. This
is more than a year later as was envisaged in 2003. The total projected cost is
R200 million. The contract does allow for penalties to be incurred if delays
are due to the contractor. Quality of the building is closely monitored by the
hospital and a report on quality issues is sent to Dept of Public Works on a
regular basis. The hospital is aware that funds need to be made available to
maintain the building and equipment the future.
The delegation enquired what the waiting time is at the hospital and the
hospital superintendent replied that hospital did a waiting time survey and the
average waiting time at admissions and the pharmacy is 90 minutes. Some
interventions were instituted and a follow-up survey showed a 30-minute
decrease in waiting time.
With regard to the Renal Unit the hospital is a satellite of the Tygerberg
Renal unit and heamo-dialysis is done for local patients. There are 6 chairs
and the hospital can manage up to 7 patients.
With regard to EMS there are problems with the local EMS due to understaffing
of vehicles.
The hospital is very aware of the shortages of nurses and doctors. The local
training of nurses addresses it in some way, but the losses are greater than
the gains at this stage. Recruitment of doctors is not such a problem, but
retention is problem, as doctors leave to go and specialise.
2.8. VISIT TO GEORGE HOSPITAL
2.8.1. Background
A major revitalisation process has been completed at the George Regional
Hospital recently. This major medical facility serves as a regional hospital
for the Southern Cape/Karoo region, as well as a district hospital for George
itself. The project focused on the improvement of the hospital's
infrastructure, technology and services to them in line with international
standards.
The National Minister of Health, Dr Manto Tshabalala-Msimang, officially opened
the revitalised section of the hospital.
All 550 000 residents of the Southern Cape and Karoo regions will benefit from
this facility. The project was completed during April 2006 and the revitalised
hospital was opened on 30 June 2006. The original construction period was 24
months and after an increase in the scope of works the contract was extended to
32 months and amounted to a total cost R152m.
2.8.2. Clarity seeking, comments and questions
Members enquired whether the hospital experiences any problems of TB defaulters
due to changes in addresses. The Hospital Manager stated that the Regional
office manages the TB-programme; the hospital manages acute TB admissions, and
discharges them to the local clinics, where DOTS and sometimes. Home based Care
take over. However, feedback from the Regional office is that there are
defaulters, the rate we are unfortunately not able to say.
Do you have a problem with absenteeism? The hospital went through a very bad
patch about three years ago, when absenteeism in the nursing group reached 38%,
the hospital then had a meeting with their Labour Caucus, and agreed to follow
the guidelines on leave and sick leave to the letter. It subsequently improved.
Currently it is at an acceptable level, and the fact that the Health Risk
Manager has taken over the investigation into applications for temporary
disability, has taken a lot of stress away from the manager.
Members wanted to know whether or not there are any problems with EMS, and how
does the hospital transport patients, and what are the responses rates like.
The Hospital Manager said that EMS does not report to the hospital. Local
problems are being addressed by the hospital. Patients are transported by road
ambulances from the surrounding towns, as well as by Red Cross Air Mercy
helicopter. Patients transferred to Cape Town are transported either by road
ambulance or fixed-wing aircraft. The response rates for EMS remains a
challenge. Should be 40 minutes in our area and 15 minutes in the metropolitan
area; it still needs a lot of improvement to reach target.
There is a shortage of nurses in the country, are you going to start nursing
training? The hospital is working very hard to establish a training facility at
George hospital. Their submission to the South African Nursing Council was
supposed to be discussed at the meeting on 20 July, but due to a full agenda,
has to stand over to the next meeting in October. In the meantime the hospital
has appointed (on contract) a manager of the school, as well as a clerk and a
secretary. One lecturer has been appointed on a fulltime basis, and the
advertisement for a second lecturer is in the media this week, also for a
contract post. The reason for the contract appointments is because they do not
have posts for a training facility on their establishment. The hospital plans
to accommodate 60 students, and will focus on assistant to staff nurse and
staff nurse to registered nurse training. Accommodation for students from
outside of George remains a headache. As part of performance management each
nurse has a development plan. These training needs are incorporated into the
hospital's Skills Development Plan. Weekly in-service training sessions take
place; nurses are sent on short courses eg ATLS, burns, midwifery, etc, and
some study with departmental bursaries (theatre, ophthalmology, admin)
In terms of Waste Management, and incinerators the service is outsourced. There
is an Infection Control Committee, meeting every two months, as well as an
Infection Control Sister.
Members raised concern that the hospital in the have overspent their budget,
where they get the "budget" from? The hospital manager stated that it
is policy that the amount overspent should be deducted from the following
year's budget. So far it has never happened. However, in the last two years
they did not overspend.
Payment patient fees is major concern across the country, and the delegation
enquired whether this is so at George Hospital? The hospital management team
replied that they found that previously it was usually the older patients who
are very conscientious with regards to paying for the services. However, there
are patients who lie about their income, and pay minimally for the service. The
hospital would like to have a private ward, but because of bed-pressures it is
impossible to do so. The hospital does attract private patients and patients on
medical aid, who share the ward with our state patients. Because facilities are
of a high standard, they actually have little to complain about.
During other oversight visits to provinces the delegation enquired if there are
any repeat TOP's and are there strategies to prevent come-backs? The
TOP-programme is co-ordinated by the Regional Office and patients are only
referred to the hospital for the actual procedure. There are definite repeats,
and the Regional director has requested the programme co-ordinator to research
the issue of comebacks and the need for TOP's above 12 weeks. Her stance is
that the system should work optimally and that all patients should be captured
before 12 weeks.
Due to the many power failures that the Western Cape has undergone does the
hospital have adequate back-up in terms of electricity to prevent what had
happened in East-London? The hospital manager stated that they do have two
back-up generators, which is tested every week, and maintained on an ongoing
basis.
The hospital manager stated that the learnership programme is co-ordinated by
the Regional Office, catering for the needs of the whole region. Currently we
have learners for basic and post-basic pharmacy assistants and nursing
assistants.
The delegation enquired with regard to the number of critical posts which are
not filled and the hospital responded by stating that currently the nursing
crisis is impacting on our service, simply because we cannot recruit enough
nurses. In the admin department we have a crisis in the HRM-section. For the
expansion and commissioning of new areas we need money.
The delegation wanted to know whether the budget in relation to your needs? The
hospital manager stated that the standard answer would be the budget is not
enough to cover all the needs. However, using population as a guide is
dangerous, because the census figures are not reliable. Using the Core Package
of Service for Secondary hospitals is also not reliable, as the hospital has a
component of Tertiary Services that should actually be funded by the National
Tertiary Services Grant. If that could be sorted, as well as the need for a
district hospital in George, leaving the hospital only concentrate on secondary
care, the budget might be enough.
3. South African Social Security Agency (SASSA)
The Committee was briefed by the Acting Regional Head of SASSA (Western Cape),
Mr D. Plaatjies.
A Service delivery improvement initiative, which was embarked on by SASSA,
includes the application turnaround time. The purpose is to reduce the time
from application to approval. The current turnaround time is 35 days. A pilot
was launched in the Eastern Cape, Western Cape and Mpumalanga. The pilot was
completed in the Bellville office (Western Cape) and rolled out to the
Worcester and Atlantis offices. It is envisaged to be implement at other 13
local offices as from July 2006 till 31 March 2006. The impact of this is that:
there are no backlogs, same day notifications, decrease in enquiries, savings
on postage etc.
3.1. SASSA establishment in the Western Cape
With regard to the establishment in the Western Cape the regional office
has been established, but certain support functions was still performed at Head
office of the Provincial Department of Social Development. The interim
management team is in place at the regional office and 16 local offices are delivering
full grant administration function.
3.2. Facilities and management systems
The regional office was completed and occupied by SASSA staff since January
2006 and the ICT infrastructure is installed and operational as well as the
financial support systems. A total of 18 local offices have been identified to
move to new premises.
3.3. Recruitment
Various posts was identified as critical which was subsequently filled at the
regional office as well as local office.
3.4. Western Cape Transfer Budget
The budget for 2005/06 amounted to R4 238 905.00 and the budget for 2006/07
amounts to R4 613 710 588.00 and a monthly amount of R368m is paid to
beneficiaries. The beneficiaries receive their monthly payments through banks,
post office (Walvis Bay) or ALLP A Y and all expenditures are monitored on a
monthly basis.
Presently there are 755,411 beneficiaries in the Western Cape receiving.
various grants.
3.5. Improvement of paypoints
SASSA is continuously evaluating all pay points to improve the conditions under
which monthly payments occur and this is done in conjunction with the service
provider.
3.6. Protecting beneficiaries: Money lending campaign
Specially designed pamphlets is distributed at pay points and imbizo's and from
time to time identified pay points are visited and moneylenders are confronted
and warned and stakeholders were identified to assist with the monitoring
process. Discussions were held with Black Sash regarding an educational
programme for beneficiaries, and a Business plan was finalized but the monetary
allocation is still to be made to Black Sash.
3.7. Clarity seeking, comments and questions
The Regional Manager informed the Committee that the current application
turnaround time is 35 days.
The Agency stated that service should revolve around the beneficiary where for
e.g. where it concerns general payments of grants; if there are older persons
in the queue they should receive preference.
With regard to the payment of grants into bank accounts and with this the
reduction of banking costs, SASSA stated that there are no reduced costs with
the banks, but that SASSA Head Office is in talks with the Commercial Banks to
reduce the costs and that this will form part of the new tender.
Members raised concern with regard to the number of contract staff in SASSA's
service. It was stated that these contract workers have a fixed term contract
of 3 years, and SASSA noted that they are unable to create permanency for these
workers. They further noted that in July 2006 Administration Clerk posts was
advertised and issues that need to be looked at is racial and gender issues.
SASSA explained that posts are firstly advertised internally to ascertain if
there are no suitable candidates within and then externally. Members enquired
whether the salary these contract workers receive are the only compensation,
and SASSA replied that the contract workers do receive and additional 30%
benefits.
It was stated by the Regional Manager that SASSA has adopted a Customer
Excellence throughout the country and it is envisaged that the level of service
should be the same throughout the country, and with this that the Agency have
to adopt and change the infrastructure, and one e.g. to enable beneficiaries to
obtain their grant anywhere in the country.
3.8. Recommendation
. Members raised concern when it was stated by SASSA that in the event that a
beneficiary passes away the day or a couple of days before payment, that that
money which is due to the deceased beneficiary can only be claimed after the
person has been buried. Members stated that in many instances that money
"owed" would assist the family members to bury the deceased.
3.9. VISIT TO SASSA REGIONAL OFFICE - BELLVILLE
At the Bellville Regional Offices the Agency gave a demonstration to the
delegation on the turnaround time of applications.
3.10. VISIT TO SASSA REGIONAL OFFICE - WORCESTER
3.10.1. Introduction
The delegation was briefed on the following: Human Resources, Infrastructure,
turnaround time of applications, anti-fraud mechanisms, achievements and
challenges at the regional office
3.10.2. Clarity seeking, comments and questions
On the issue of money lenders the Agency stated that this a project which has
been running for years and that beneficiaries are educated as to the
"dangers" of this and the Agency even went so far as to arrest these
people.
The Agency stated that a specific day is set out for the payment of grants to
older persons and older persons do get preferential treatment on other pay days
and the Agency has been consulting different organisations to educate older
persons.
Members enquired what the situation is with regard to the grants which
beneficiaries receive which are then given to institutions e.g. old age homes
etc. The Agency stated that there is no set formula and that it is a certain
process, which goes through SOCPEN, and that it is an agreement between the
institution and the beneficiary. The Provincial Department of Social
Development stated that the monitoring of this is huge problem for the
department. They further noted that a Monitoring and Evaluation (M & E)
Directorate has been established at Head Office which visited about 600
institutions. It is envisaged to decentralize M & E to the districts, since
the districts are in a better position to deal with this.
With regard to foster care placements the department stated that after 2 years
the social worker must report to the department what has been done to place
this child permanently. The department stated that they rely very much on
strong community based organisations. The department stated that social workers
are a major problem in the rural areas, but there is a 24 hours service at the
office to phone the social workers in case of emergencies.
On the issue of the volunteers as commissioners of oaths the Agency stated that
they make use of the SA Police Service as well as Commissioners of Oath as
appointed by the Department of Justice and Constitutional Development, but that
there is still problems. SAPS complained that the Agency was clogging up their processes
with the number of documents. What is needed is a network of commissioners.
SASSA stated that they do make available funds for doctors to the Department of
Health, where these doctors go to the clinics and hospitals to check where the
backlogs are.
3.10.3. Recommendations
·
That the issue of money lending and the confiscating of cards in the
region are re-Iooked at and that the culprits must not get away with it and
those beneficiaries needs to be protected against this "practice".
·
That the shortage of Commissioners of Oaths in the region be addressed.
DEPARTMENT OF HOME AFFAIRS
4.1. Visit to Department of Home Affairs Regional Offices - Worcester
The Provincial Manager (Western Cape) of the Department of Home Affairs briefed
the Committee on state of affairs in the province, with reference to Human
Resources, Budget, Infrastructure, Service delivery and Partnerships and
outreach programmes.
After the presentation of the Provincial Manager, the Regional Manager for the
Sub region briefed the Committee.
The Regional Manager informed the Committee that the District Office (DO)
Worcester is one of three districts under the jurisdiction of the Paarl
Regional Office.
He noted that Worcester is serving various areas including Ceres, Tulbagh, and
Robertson etc, of which the furthest distance is 85 km. It operates with a
personnel of 17 officials. The online hospital in the sub region is Eben Donges
Hospital in Worcester.
The present accommodation utilized by the DO Worcester was recently upgraded by
the owner and a new counter was installed and renovations was done to the
bathroom facilities, etc and the office was painted with the corporate colours
of the department. Air-conditioners were installed in 7 offices
4.2. Challenges
To keep rendering the services at mobile points; the expedite the processing of
enabling document applications; to provide the relevant training to officials;
to secure suitable, additional accommodation for the current and new additional
staff; to get uniformity in the application of the Immigration Amended Act
& Birth and death Registration Act.
4.3. Achievements
The establishment of permanent Service points/mobile venues in the regions;.
capacitating of offices in the regions; rendering service to the poor of the
poorest in remote areas with the 2 mobile trucks; filling of all advertised
posts; queue management systems implemented; optimal utilization of mobile
trucks in the region.
4.4. Clarity seeking, comments and questions
The delegation commented with regard to the migration of clients from the poor
provinces. How does this effect service delivery and how does the Department
cope with the migration? The department replied that most of the clients in
Paarl Sub Region are from the Eastern Cape. The Regional Manager questioned
Example, Lesotho citizens pretending to be from the Eastern Cape, at this
office. It was established that they are in fact from Lesotho. The departments
often receive complaints that people have tried to obtain Identity Documents in
their Home Province but were not assisted by Home Affairs officials and the
Malmesbury office reports that a councilor presented eight people as South
Africans. When interviewed in depth, four of them were found to be from
Lesotho. It is unbelievable that
Members enquired about the turn around times - and how the department intended
to adhere to turn around times with the little resources (human) to their
disposal? The department stated that staff is optimally utilized and recently
51 learners were deployed to assist.
Members raised concern why the approved structure is not capacitated - 878
approved and only 458 filled? Is DHA improving skills and employing unemployed
and qualified persons? The department stated that the New Organisational
Structure was approved by Minister on 2006.03.16 and out of the 878 approved
posts 267 is not funded. All unfunded vacancies were funded over with the MTEF
2007 input. Only153 funded vacancies remain of which: 76 Mabelane posts on
level 2-5, plus 67 was advertised, plus 10 posts reserved for the absorption of
contract workers, 153 funded vacancies.
Members wanted to know what the province's strategy will be regarding
preparation for 2010. The department replied that devolution of powers to
Regional Managers for the approval of Temporary Residence applications where
management will be streamlined to enhance service delivery. Capacitating
Saldanha Bay, Mossel Bay harbour as well as the staff compliment at the Cape
Town International Airport. A request has been submitted for a budget (Cape Town
Harbour, Mossel Bay Harbour, Saldanha Bay Harbour and Cape Town International
Airport) in order to activate the above strategies.
The delegation raised concern regarding the deportation list, that only Amcan
people are reflected on the presentation. How many white people were deported
and why was this not reflected? The department replied that recently a
paedophile German was deported as well as a Chinese national - fugitive before
justice for fraud and armed robbery. The Cape Town Inspectorate is currently
busy with the deportation of Laura Brown (American national) responsible for
stem cell fraud. If Europeans are apprehended, they normally have enough funds
to leave voluntarily, whereas migrant workers often do not have sufficient
funds to leave voluntarily and have to be deported. Whenever an illegal
foreigner is apprehended they are given the choice to leave on own funds or be
deported on state expenditure. A Belgian Citizen was recently deported from
Malmesbury through Lindela.
The department noted that birth registration at hospitals is not compulsory,
only if the client wants to register the child the service is at hand. Only one
hospital in Paarl Sub Region Online: Eben Donges in Worcester. A total of 281
births were registered since the facility was opened. Paarl General Hospital
will go online as soon as building operation at hospital is completed.
What is DHA: Western Cape doing to curb corruption?
·
Ensure that proper control measures are in place.
·
Whistle Blowing/fraud prevention policy workshoped with staff members and
written confirmation of adherence requested afterwards. . Supervisors urged to
report irregularities.
·
Capacitated the Counter Corruption component of the Provincial
·
Managers Office by the employment of a Control Security Officer (18 April
2006)
·
All cases of possible corruption are submitted to Directorate Counter
Corruption for investigation.
·
The Province established a close working relation with Provincial NIA.
·
The province embarked on a project to vet all managers from level 7-14
with the buy-in of the National Intelligence Agency.
The delegation wanted to know how tight security at ports of entry is -
foreigners smuggling drugs enter the country through International Airports.
How many of these cases did you register and how do you manage them?
Identification of drug smugglers is the mandate of Customs and Border Police
(Organized Crime Unit). Interacting does however exist between immigration and
other law enforcement agencies. The Immigration staff facilitates the processing
of admission of a person to the RSA. Security at Cape Town Harbour -
responsibility of the Maritimes Company and Port of Entry Security Enhancement.
Security at Cape Town International Airport Airports Company.
Members enquired what interns and learners receive as remuneration form the
department? The Provincial Manager stated that interns receive a monthly
stipend of R3000.00 per month and Learners are remunerated with R2000.00 per
month from the budget of the Director: Human Resources.
Where do you detain illegal foreigners before deportation? Local Police station
for a maximum period of 48 hours, Polls moor Prison and Malmesbury.
4.5. VISIT GEORGE REGIONAL DEPARTMENT OF HOME AFFAIRS OFFICES
4.5.1. Introduction
The Office Manager briefed the delegation on the following: Human Resources,
Budget, Infrastructure, Service delivery and Partnerships and outreach
programmes.
4.5.2. Clarity seeking, comments and questions
The delegation enquired why the vacancies within the Region are not filled and
the department replied that all funded vacancies were advertised and are in
various stages of filling.
The delegation wanted to know how the regional office distribute ID's to those
people whose ID's are still in the office? The Department stated that it has
signed a contract with the South African Post Office. SAPO officials are
collecting ID's from the offices. After distribution SAPO submits a list of
applicants delivered to as well as pink cards where applicant sign when
receiving his/her ID. SAPO officials take great care when delivering these ID's
by ensuring that the ID is handed to the owner.
Marriages are conducted at Regional Office George twice a week (Mondays and
Wednesdays). It sometimes happen that clients turn up without knowing the
designated day for solemnization of marriages, these clients are never turned
away if all necessary documents and witnesses are present. The George Office
conducts 15 to 25 per month.
The department noted that this office experienced one incident of fraud in 2004;
the case was investigated and finalized early in 2005. The official was
dismissed. Since then the Departmental Fraud Prevention plan was workshopped
with all staff. A control measure with regards to the handling of cash was also
enhanced.
The delegation enquired why there is no staff at Knysna while it is regarded as
a district office and the department replied that the Regional Manager is
currently in the process of negotiating office accommodation in the Knysna
area. The establishment for District Office Knysna was approved in 2006, but
not funded for 2006/07 financial year.
The department informed the delegation that during the migration process from
the 1995 establishment to the 2004 establishment a mistake occurred during
which the component number for DO Beaufort West was abolished. At the time the
staff deployed at the Beaufort West office was accommodated on the
establishment of Oudtshoorn. A component number for District Office Beaufort
West needs to be created. The Provincial Office is addressing the issue.
In its presentation the department talked about the biometric system and the
delegation wanted to know whether any problems are experienced with the
Biometric system? The department stated that
The delegation enquired what the turnaround time is for processing
certificates and the department stated that unabridged certificates are issued
on the spot and at times when computers are offline certificates are posted to
the applicant.
During the period of the oversight visit the region was flooded and the
delegation enquired what mechanisms are in place to assist people affected by
the floods. The Regional Managers is working closely with the local Disaster
Management Components of the local Municipalities. After an assessment was made
of the flooded areas and the needs of the affected people, a submission
requesting the waiving of fees are directed to the Director General via the
Office of the Provincial Manager.
The delegation raised concern that it seems as if its only Africans are
targeted by Immigration (evident from the presentation) and deported while
non-Africans are left to leave the country on their own? The Provincial Manager
stated that the National Immigration Branch of the Department of Home Affairs
has a mandate to investigate arrest, detain and deport transgressors of the
Immigration Act no 13 of 2002 together with other related Government Act.
Well-qualified and trained Immigration Officers countrywide carries the mandate
indiscriminately. As according to the Act those who are declared as illegal
foreigners are removed from Southern Cape to Lindela Repatriation centre, which
serve as an exit point, to the country of origin. When an illegal foreigner is
arrested, he or she will be given an option of either leaving the country on
his or her own account or either waits for Immigration officials to deport him
or her at the state's account. Those who are willing to deport themselves are
issued with an "Order to Leave the Republic (Form 21), to leave the
republic on their own. Some Africans and non-Africans at times opt to remove
themselves out of the country especially when they have money to do so. But
most Africans cannot always afford to deport themselves as a result of lack of
financial support.
The delegation wanted to know where illegal foreigners kept prior their
deportation. All illegal foreigners are kept temporarily in Police Stations
around the Southern Cape for 48 hours. They are further transferred to Prince
Albert Correctional Service Centre within 48 hours. Prince Albert is our
detention facility where illegal foreigners await for their deportation. Prince
Albert is about 150 kilometers out of George. The centre is 140 kilometers away
from George Office. The centre is specifically assigned to accommodate illegal
foreigners only. Before they could be moved to the centre, they were being
accommodated at George Correctional Centre, which was not a suitable place.
Cases of assault against the foreigners were registered. The detained are
deported twice a month out of the Southern Region in a joint operation with the
Immigration Inspectorate of Cape Town.
WAY FORWARD
The Committee will undertake follow-up visits to the province, in order to
provide oversight and monitor progress made with regard to some of the
challenges raised by stakeholders during the oversight visit.
The Committee will take up some of the issues raised with the Department of
Health, and will continue provide oversight on departmental strategic plans to
ensure that the relevant issues are taken up in strategic and operational
plans.
Ms JM Masilo
Chairperson: SC on Social Services
Date: