June 19, 2018

Taking Parliament to the People of Free State

A report tabled in Parliament this week on the most recent “Taking Parliament to the People” (TPTTP) contains an appendix listing citizens’ appeals for help.

The appendix alone runs on for 40 pages, or two-thirds of the report.

This year’s TPTTP was held in Botshabelo and Xhariep in the Free State. Its focus was mainly on the provision of health services as well as the rights of patients, but it lists about 330 stories of ordinary folk who want their leaders to hear about their daily reality.

Twice a year Members of Parliament leave the comforts of the Cape Town precinct and with their counterparts in provincial legislatures they go out to communities, usually in far-flung rural areas, to do exactly what the name of this parliamentary programme implies. They take Parliament to the people.

Citizens queue patiently for an opportunity to list their problems and demands.

Thousands of citizens who have never got any closer to their elected representatives than their TV screens flock to meet them. They queue patiently for an opportunity to list their problems and demands.

These are people who don’t normally get visitors who require hotel accommodation and drive in blue light, multi-car cavalcades. But credit to the Members. They put up with accommodation unlike anything they have become used to. And when the motorcades cruise to a stop, an unusual sight unfolds. Smart city types, in their heels and handbags, the men sometimes even in ties, make their way through dusty building sites, or past long queues outside prefabricated clinics, or to mud schools with pit latrines, or smallholder farming plots. They have come to speak to the people, and that’s what they do.

Does it make a difference? Well, that’s debateable. There is often a happy ending. Someone who has been waiting for longer than they can remember gets a house, another may get electricity which enables him or her to start up that business they have long dreamed of or a school gets running water or flush toilets.

Others get only promises that something will be done, while many go away empty-handed. But the report becomes part of the parliamentary record and shows Parliament at work doing what it is supposed to do, which is overseeing service delivery by government and engaging with the people.

This week’s TPTTP report contains a litany of challenges facing some of the Free State’s medical facilities. The oversight team, divided into five delegations so that it could visit as many sites as possible, covered 34 sites in four days.

What they found makes for grim reading. Free State has 212 clinics, 10 community health centres and 75 mobile clinics at district level. Hospital services are provided through 24 district hospitals and four regional hospitals, which are spread throughout the Province. There is a single specialised psychiatric hospital, one tertiary hospital and one central hospital located in the Mangaung Metro.

The Free State Department of Health (FSDoH) 2017/18 budget has not kept up with inflation as expenditure increased nominally from R562 million in the 2016/2017 financial year to R590 million in the 2017/2018 financial year, a decrease of 1.21% real terms.

Free State has its fair share of South Africa’s usual diseases – or perhaps an unfair share. According to the TPTTP report, the province “faces multiple, simultaneous burdens of diseases such as persisting communicable diseases with pneumonia, influenza, and tuberculosis ranking high in all the districts.

“There is an increase in chronic diseases such as heart disease, mental illness, cancers, hypertension, and diabetes mellitus. HIV and AIDS ranks tenth in Free State for mortality and causes of death.” Recent statistics show that vaccine-preventable diseases are well-controlled in the province but mortality due to diarrhoea was especially high among children under-five years of age, probably due to HIV and malnutrition.

The report lists defects and maintenance backlogs in the Mangaung Metro and Xhariep District health facilities. The delegations reported that they encountered “dilapidated infrastructure, poor plumbing, deficient ablution facilities, inadequate physical space, decrepit furniture, as well as malfunctioning boilers, air-conditioning and backup generators.

“Some facilities require urgent refurbishment, given the extensive structural and maintenance defects, for example, Pelonomi, FS Psychiatric Hospital, and Dinaane, Gabriel Dichabe, Klipfontein clinics, and others. Of particular concern is that in some instances the lack of maintenance is attributed simply to the absence of the requisite tools,” the report states.

The most severe defects were encountered at the Pelonomi Tertiary Hospital where the infrastructure is so old that its boiler has to run at maximum capacity, adding additional pressure to the electrical grid, which then also has to function at maximum capacity. Several infrastructure projects located at Pelonomi are running years behind schedule.

Urgent attention is needed for the Free State Psychiatric Complex (FSPC) which is reportedly not compliant with the relevant infrastructure standards. A particular risk at FSPC is that due to its dated physical infrastructure it is susceptible to electrical fires – with several reported over the past few years.

Although medicine supplies generally meet the 95% required limit, the problem lies in storage. Medicines are kept in unlocked cupboards in public areas and broken-down air-conditioning and fridges means that limited batches can be ordered at a time. Sometimes domestic fridges are used to store vaccines or cultivars and these can spoil when electricity shuts down.

Across Xhariep and Mangaung districts, reports were collated of the lack of essential equipment such as BP machines, ear, nose and throat sets, and glucose metres. Inferior medical equipment was procured, due to supply chain management procedures requiring that the lowest quotes be accepted. The poor quality of consumables provided by contactors were regarded as tantamount to fruitless and wasteful expenditure by some facilities.

A central theme was that medical equipment is poorly maintained and some nursing staff lack adequate training on use of medical equipment, which is therefore not optimally used. The Fiber Optic Macintosh Laryngoscopes and BP machines were specifically mentioned. Also due to inadequate training, weight measuring scales were not calibrated.

Patients’ record-keeping is still done manually at the two major hospitals of Universitas and Pelonomi, which increases patient waiting times. Sometimes records are stored in different locations due to lack of space. At Pelonomi, patient records are stored in three different locations, compounding retrieval problems. At the Dr JS Moroka hospital, the average patient waiting time of 192 minutes was attributed to delays in the retrieval of patient files. At Universitas, a stack of documents could not be matched to patient files.

One of the most serious problems was high vacancy rates reported across all the facilities visited. At the Free State Psychiatric Complex one nurse is assigned to three wards with approximately 90 patients during night duty.

The FSDoH is currently under administration by the Provincial Treasury due to irregular expenditure, excessive accruals, poor contract management, poor revenue collection and debtors’ management, poor supply chain management practices, uncontrolled overtime claims, the absence of internal controls and cost control measures, poor monitoring of infrastructure and asset life management, and outdated human resources policies.

Financial constraints and cost saving measures were felt at all the hospitals visited. Universitas received a 5% increase in its 2017/18 budget, although salary increases of 7.5% had been negotiated. Botshabelo reported that it is currently overspending about 4% percent on remuneration and it is highly dependent on the National Tertiary Services Grant (NTSG). In addition, in terms of a bilateral agreement between South Africa and Lesotho, the hospital provides services to residents of Lesotho. However, Lesotho currently owes Universitas R81 million.

The budget of the Dr JS Moroka hospital has been reduced by R6 million to R110 million. This has meant non-payment of overtime claims, which means the hospital is unable to provide after hours and weekend pharmaceutical services, radiology and maintenance.

The report cites that FSDoH currently faces 216 pending legal cases worth slightly over R1.4 billion, as well as an additional 29 medical legal claims to the value of R239 million (for which it has no medical records). It is reported that the medical and legal FSDoH team is not equipped to counter medical legal cases and litigation poses a serious risk, threatening to divert much-needed resources away from medical services.

Moira Levy

Additional Info

  • Author: Moira Levy
Last modified on Tuesday, 16 January 2018 18:20

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