the Portfolio Committee on Health on the oversight visit to Mankweng,
1. Introduction and objectives
The Portfolio Committee on Health undertook oversight visits
to a number of public health facilities in the
· Assess infection control strategies and the quality of health services;
· Gain insights on the functioning of the tertiary, district and primary health services in the province;
· Observe facilities for child-birth in line with the United Nations Millennium Development Goals (MDGs) 4 and 5. These Goals are to reduce infant mortality and maternal mortality respectively; and
· Assess security in the above-mentioned public health facilities.
In addition, although there are few or no reported cases of
initiates’ deaths in
The multi-party parliamentary delegation comprised the following Members of Parliament, with accompany support staff:
African National Congress
Inkatha Freedom Party
Congress of the People
Ms MC Dube;
Ms TE Kenye;
Ms LS Makhubele-Mashele;
Ms RM Motsepe;
Ms BT Ngcobo; and
Ms MJ Segale-Diswai
Ms E More and
Mr M Waters
Ms HS Msweli
Mr DA Kganere
Ms V Majalamba: Secretary;
Ms N Mahlanyana: Assistant; and
Mr Z Rahim: Researcher
3. Hospitals visited by the delegation
The parliamentary delegation visited the following hospitals with a view to obtain first hand knowledge of the challenges faced by these public medical facilities:
· Madombidza Clinic
4.1 Delegation from the hospital
Ms MM Monale, Acting Chief Executive Officer; Dr TM Pinkoane, Senior Clinical Manager: Pietersburg Hospital; Dr CT Ntoane, Manager - Oral Health Services; Sister Lydia Maloba, Infection Prevention and Control: Pietersburg Hospital; Mr Harold Malatji, Infection Prevention and Control: Pietersburg Hospital; Ms Peggy Duba, Acting Nursing Manager: Pietersburg Hospital; Ms Matlakala Gladys Madibane, Assistant Manager-Nursing; Ms Grace Mmatloe Lebese, Assitant Manager-Nursing; Dr RM Mahladi, Senior Clinical Manager; Ms ME Matlou, Quality Assurance Coordinator; Ms MCM Magagane, Quality Assurance Coordinator; Ms EM Legodi, Acting Campus Manager: Pietersburg Hospital; Ms MM Mogashoa, Infection Control Nurse; Ms ML Maloba, Acting Nurse; Dr M Shoyeb, Acting Senior Manager; Ms M Suzan Mehape, Manager; Ms V Khangala, Senior Manager-Finance; Ms SM Makwela, Information Deputy Manager; Ms Q Nenzhelele Hlamalani, Operational Manager: Louis Trichardt Memorial Hospital; Mr Daniel Sunduza Maluleke, Manager- Risk and Security.
4.2 Walkabout around the hospital
On arrival, the parliamentary delegation was taken on a tour of the hospital facilities, and also provided an overview of the conditions. The delegation visited the Obstetric Department, Neonatal Intensive Care and High Care Unit and the Radiology and Radiography Units.
4.2.1 Obstetric Department
Members observed that infection control would be a problem as
there was an absence of hand sprays, shoe gloves and other protective measures.
In response, the Infection Control Officer noted that infection control was not
The challenges in this department comprised the following:
· Staff shortages were reported in the wards. The nurse to patient ratio was 1:3 or 1:4. The Ward had 32 registered nurses, eight enrolled nurses, 80 nursing assistants and seven general assistants;
· Equipment and consumables were not always available: Electrocardiogram (ECG) machines had to be rotated as there was a shortage;
· The hospital did not have an isolation ward, but used a side ward, when needed;
· Maintenance of equipment and infrastructure was a challenge. The hospital’s own maintenance unit was used for this instead of the Department of Public Works. For four to five months no water was available and the hospital had to improvise. This was due to a water reticulation issue at the hospital; and
· The hospital was still waiting for transport incubators, which were ordered in March 2011, and four out of seven were being repaired. Procedurally, first the Clinical Engineering Unit undertakes in-house repairs and, if needed, it is then sent to a company for repairs. If new incubators need to be procured, the Bid Committee would handle the matter.
4.2.2 Neonatal Intensive Care Unit and High Care Unit
The unit consisted of eight high-care and eight intensive care unit beds. The Neonatal ward has a Kangaroo Mother Care Unit, which allowed, amongst other things, mothers to have skin-to-skin contact with their premature and underweight (under 1 kg) new-borns as this had been shown to be beneficial to the babies’ development.
The procurement process at the hospital was very slow, and this resulted in the hospital having to return unspent money to Treasury.
4.2.3 Running of the pharmacy
The pharmacy served 21 clinics, including 10 outreach clinics, as well as the wards at the hospital and outpatients Section. It was staffed by 13 pharmacists, including five community service pharmacists as well as nine interns and nine pharmacy assistants. Six staff members go out daily to clinics. Five vacancies were reported for pharmacists, including one for a community service pharmacist position. The average waiting time for service was between 24 minutes to 2 hours. The challenges noted were:
· The ARV clinic needed a CCTV but there were too many zones to cover;
· The pharmacy itself also needed a CCTV. The process was going to take approximately six months, which was going to be a challenge to its accreditation; and
· The pharmacy struggled to obtain stock as amounts over R150 000 had to go through an adjudication process, which was quite slow.
4.2.4 Radiology and radiology services
The Mammography Unit, which was transferred from the
4.3 Briefing by the Acting CEO on the profile
Having completed the walk about, the Acting CEO, Ms Monale presented the Mankweng
Profile to the Committee. She informed the Committee that
The hospital was built in and commissioned on 1 July 1988, and was opened officially by the Chief Minister of Lebowa Government, Mr Noko Ramodike.
The Committee was informed that the hospital was a tertiary academic institution, which promoted and rendered quality, comprehensive health services for all. The mission of the hospital was to provide accessible, sustainable tertiary services, community orientated training, development and research.
4.3.2 Strategic Development of Polokwane/Mankweng Hospital Complex (PMHC)
The CEO informed the Committee that after the elections in 1994 the Department established a commission on Provincial Tertiary Services. The commission came up with a clear plan with three hospital levels of care and the designation of each hospital into one of the three levels. After consulting with the relevant stakeholders, the commission recommended that Pietersburg Mankweng Hospitals be merged into a complex with combined number of beds of 1016.
The role of the PMHC was to provide tertiary services to all
level 1 district and level 2 regional hospitals in the
served as primary hospital for its surrounding community. The hospital also
served as the secondary hospital for Capricorn District. The hospital had
tertiary services for
184.108.40.206 Academic Component
The CEO informed the Committee that the academic component
was jointly administered by PMHC and the
Mankweng had 509 usable beds including 27 sub-acute beds.
220.127.116.11 Staff component
The complex approved staff component was 6090 of which 2806
were filled. The vacant posts were 3284 and the vacancy rate was 53.9%. The
approved staff component for
18.104.22.168 Concerns raised by the Committee
In response to the input provided, the Members raised the following concerns:
· Staff shortages were far too high, and might compromise the services provided. This was evidenced by the long waiting period at the OPD;
· If the CEO was working in an acting capacity, the lack of permanent leadership might impact on the functioning of the hospital in the future;
Kangaroo wards within the
maternity section had proved useful in other hospitals, but the
· In terms of shortages and lack of infrastructure, the committee noted the following: Shortage of beds and stretchers; ICT infrastructure was lacking, particularly for the academic campus; office and residential accommodation was limited; absence of maintenance of medical equipment; no maintenance of infrastructure; a shortage of artisans; no proper record management; inadequate space; and shortage of staff accommodation, which made it difficult to attract staff.
5.1 Delegation from the Hospital
Ms Constance Rauling, Acting CEO; Mr Rex Maleke Magampa, Acting Allied Manager; Ms Mr MP Tshikota, Professional Nurse Speciality; Ms GR Mashamba, Operational Manager; Ms MP Malumane, Assistant Manager-Pharmaceutical Services; Ms B Maguga, Assistant Manager-Nursing; Ms Queen Hlamalani Nenzhelele, Operational Manager; Ms Patricia Khomunala, Professional Nurse Speciality; Mr AR Nemakonde, Acting Deputy Manager; R Kutelani Sigide, Deputy Manager: Communications; Ms Nemetali Nndweleni, Acting Deputy Manager; Ms Mukwevho Tshilidzi Suzan, Deputy Manager-Security Risk Management; Ms Joyce Mutulal, Operational Manager; Dr F Davachi, Acing Clinical Manager; Mr Margaret Audrey Dagaba, Principal Medical Officer; Ms Jacqueie Sadiki, Senior Provisioning Administrative Officer-Supply Chain; Ms NJ Nyase, Deputy Manager - Finance; Ms AP Mawashe, Deputy Manager - Quality Assurance; Ms MJ Mabasa, Human Resources Manager; Ms PM Musitha, Operational Manager – ARVs; Ms ME Matidze, Senior Manager and Ms Deliwe Nyathikazi, Senior General Manager, Limpopo Provincial Government.
5.2 Walkabout around the hospital
On arrival, the parliamentary delegation was taken on a tour
of the hospital facilities, and also provided an overview of the
conditions. The delegation visited the Takalaninanne Clinic, the pharmacy, outpatients department,
casualty ward, maternity ward, delivery room, admission and post caesarean room
5.2.1 Takalaninanne Clinic
The clinic was within the hospital. HIV Counselling and Testing (HCT), Sexually Transmitted Infections (STI), Antiretroviral Treatment (ART) and TB services were provided at the clinic. The clinic also offered family planning. The pharmacist informed the Committee that they did not have support groups because patients wanted to be provided with food and the clinic could not afford to provide it.
The clinic was operating with one doctor and when the clinic was busy, a doctor would come from the wards to assist.
There were different counselling rooms in the pharmacy area. The pharmacy attends to approximately 2000 ARV patients a month.
The pharmacy was very small with falling shelves. The pharmacist informed the Committee that if the pharmacy had a shortage of stock, the hospital usually borrowed from other hospitals. In the case where there were ARVs shortages, they would halve the drugs so that the patients could share (instead of giving patients drugs that would last for a month, she/he was only given enough to last for 15 days).
The other challenge that was mentioned by the pharmacist was that sometimes there were no stock at the medical depot.
5.2.3 Out Patients Department (OPD)
The OPD had six single cubicles. On the day of the visit, the OPD was overcrowded. The patients on being asked the length of time it took for them to receive attention complained that it took very long and sometimes a patient would come in the morning, and would only be attended to very late in the afternoon.
The Committee was concerned that children and adults waited in the same area and this might result in cross infections.
5.2.4 Casualty Ward
The sister in charge of the casualty ward informed the Committee that due to a shortage of beds in the hospital, they sometimes had to keep patients for two days in casualty and sometimes patients had to sit on the bench due to the shortage. The casualty ward was short of stretchers, and only four belonged to the premises.
5.2.5 Maternity Ward
The maternity ward was attending to approximately 150 vaginal deliveries a month. The ward was also dealing with unbooked cases. The sister in charge informed the Committee that the ward needed more space and more beds. In some instances, patients in labour deliver their babies while sitting on chairs.
5.2.6 Delivery Room
There was no protection clothing in the delivery room. The sister in charge informed the Committee that they sometimes dealt with 25-30 deliveries and had only nine rotating professional nurses. There was no kangaroo room. The ward was short staffed of two operational managers.
5.2.7 Admission and Post Caesarean Room
The post caesarean room was a two-bedded room. The sister in-charge informed the Committee that when the need arises, it was also used as a three bed unit because the hospital could not chase patients away.
5.3. Meeting with the Hospital Management
Having concluded the walk about, a meeting was held with the
hospital management. Ms Raulinga, the Acting Hospital
CEO briefed the Committee and presented an overview of the
The hospital was situated along the N1 road towards
5.3.1 Strategic priorities of the hospital
The CEO highlighted the following as strategic priorities of the hospital:
5.3.2 Services rendered at the hospital
The following services were offered at the hospital - Accident and Emergency Care Services; Medical and Surgical Care; Maternity Services; Paediatric Services; Reproductive Health Services; Nursing services; HIV/AIDS, Sexually Transmitted Infections/TB management; Occupational Health and Safety Services; Infection Prevention and Control Services; Laboratory Services; Pharmaceutical Services; Occupational Services; Physiotherapy Services; Speech, language and audiology services; Social Work Services; Dietetics Services; Clinical Psychology Services; Optometry Services; Radiology Services; Dental and oral Health Services; Outreach programme; Quality Assurance Programme; Risk and Security Services; Catering Services; Laundry Services; Housekeeping Services; Mortuary Services; Communication and Community Liaison Services; Information and records management; and Birth and Death Registration Services.
5.3.3 The most common diseases experienced in this area are:
Gastroenteritis; Pneumonia; Anaemia; Diabetus Mellitus; Pulmonary Tuberculosis; Hypertension; Retroviral Diseases; Motor vehicle accident cases; Congestive cardiac failure and Asthma.
5.3.4 Human Resources and Financial Management
The CEO mentioned that in strengthening the Human Resources Management planning and Management there were challenges with regard to shortages of doctors, professional nurses and male nurses and clinical support practitioners.
On financial management services, the challenges mentioned by the CEO was that service providers do not allocate the budget according to the headcount, and incomplete projects that stymied the work of the hospital.
On pharmaceutical services, the challenge mentioned was the shortage of medication from the pharmaceutical depot.
On strengthening outreach programme, the CEO informed the Committee that there were no challenges.
In providing quality patient care, the challenges noted relate to chronically ill patients and orthopaedic patients who stayed too long in the hospital. Most of the deaths at the hospital were HIV-related complications. The hospital saw a high number of accidents, which happened next to the tunnel on the N1. The maternal deaths were caused by late referrals from clinics and HIV/AIDS complications.
5.4 Ministerial Priorities
The hospital was working towards attaining the Ministerial priorities and the following were projects the hospital was embarking on:
5.4.1 Hygiene and Cleanliness
The CEO stated that the buildings and grounds were not adequately cleaned. The main challenges that led to this were shortage of cleaning staff and the overgrown grass during rainy seasons. In addressing the above-mentioned challenges the hospital would fast track the appointment of staff members. The cutting of grass had also been outsourced.
5.4.2 Improve quality of health care
In terms of the measurable objective of improving patient safety, as per the Ministerial priorities, the hospital identified the following gaps:
· Overcrowding of patients in the wards due to infrastructural challenges; and
· Absconding by patients, theft of babies due to unavailability of CCTV and security doors, palisade fence and the main gate of the hospital.
In addressing the challenges, the hospital had motivated for the expansion of the hospital. The maternity and paediatric ward now had security doors. In motivating for the facilitation of installation of palisade fence and the main gate of the hospital, a presentation had been made to the acting District Executive Manager.
The hospital also had a challenge of non - compliance or non - adherence to infection control standards. The following were the planned activities to address the challenge:
The hospital also faced challenges of infrastructure in management of medical waste. To address the challenge, the hospital had erected a central storage for medical waste. There was a ward attendant that assisted in collection of medical waste from the wards.
5.4.3 Reduce Waiting Time
The hospital had reduced patient waiting times from 1h48 minutes to 1h17 minutes.
5.4.4 Drug availability
In ensuring, that there were no drug shortages at the hospital, the hospital would continue to borrow from other hospitals and would continue making follow ups with the pharmacy depot.
5.4.5 Concerns raised by the Committee
The Committee raised the following concerns in relation to
· The congestion of hospitals aggravated the conditions and patient care provided;
· The fact that babies and children waited in the same OPD as adults might pose a risk of cross-infections;
· There was no 24-hour emergency service clinic; and
· There was no public transport close to the hospital and the Committee raised concerns on the way in which patients travelled to the hospital.
6. Madombidza Clinic
The clinic opened in May 2011, and had four consulting rooms. The clinic used the supermarket approach, which was to get all the services under one roof on any specific day instead of having to come back for a service on a specific day.
The clinic dealt with approximately 25-30 deliveries a month. The clinic had renovated the nurses home. The clinic attended mainly to stabbed cases, which resulted from drunken brawls. The clinic was next to a tavern.
HIV patients were also attended to at the clinic and there were 302 patients on ARV treatment, and approximately 415 were not on treatment.
The clinic had a standby solar in case it ran out of electricity. The provincial department controlled the maintenance budget. Supervisors from the province visit the clinic on a monthly basis.
The clinic was out of Intravenous Sets (IV) for the whole month. Sometimes the clinic operated without vaccines. At times, the clinic had syringes and no vaccines, or vice versa.
The nurses were staying in the clinic to wait for emergencies.
Having concluded the visit at the different health institutions, a meeting was conducted with the Member of the Executive (MEC) on 12 August 2011.
6.1 Representatives from the provincial department
The following representatives from the provincial department also attended the briefings - Ms Daisy Mafubelu, Head of Department; Ms Queen Hlamlani Nenzhelele, Operational Manager; Ms Molly Johanna Mabasa, Senior Manager; Mr RA Matsimela, Parliamentary Officer; Ms MMP Monale, Acting CEO; Mr T Makgolane, General Manager; Mr N Mathoba, Acting General Manager; Mr Victor Mojakgomo Maserumule, Manager; Mr Chuene Rammutla, Senior Manager; Mr VE Buthelezi, General Manager; Mr NP Kgaphole, General Manager; Mr Ms Bogale, District Executive Manager; Mr Jacob Gandi Moetlo, District Executive Manager; Mr Machille Thobejane, District Manager; Mr M Nkadimeng, Senior General Manager; Mr Kgabo Hlahla, General Manager; Mr R Khazamula Mashaba, General Manager; Professor F Mushwana, Chief Finance Officer and Ms Deliwe Nyathikazi, Senior General Manager.
7. Responses from the Department
A number of findings were highlighted during the oversight trip by the Portfolio Committee. These were responded to by the Department. Following below are detailed responses to some of issues highlighted:
The province was not planning to extend
· The province had identified all the senior manager posts as critical positions and these would be filled;
· There was a problem of patients’ ‘by-passing’ lower levels. To address this challenge the hospitals were working with communities and hospital boards;
· There were serious issues at the pharmaceutical depot, from the time of ordering and receiving some medication. Some medications did not reach their destination;
· The province was looking at the number of on-call clinics, and looking at an option of transforming them to 24-hrs services; and
· On CCTV cameras, the department had taken a decision to improve security in hospitals and procurement was attending to the issue.
In response to the issues raised, the following was noted:
· The management stated that it would conduct unannounced visits at different health facilities in the provinces, and hoped to conclude visits by the end of 2011; and
· The MEC promised that the Department would take some of the findings up, and a report would be forwarded on progress.
8. Findings by the Committee
After the visits to the institutions, the Committee concluded with the following findings:
· There were staff shortages at all visited institutions;
· There were no recruitment and retention strategies at all visited institutions;
· There were too many acting positions in both hospitals;
· All visited institutions do not have infection control strategies;
There was a shortage of equipment
as well as old equipment, especially in the kitchen at
The primary healthcare was not
working well especially at Mankweng and
· Hospitals sometimes experienced shortages of medication;
· There were serious challenges with the medical depot as the depot at times did not have essential drugs;
The population around
The budget allocated to
The CCTV cameras were not working
Having considered the findings, the Committee recommends the following:
The Minister of Health should ensure that the health
department in the
Report to be considered.