Eastern Cape health department continues to use mud clinics
It is just another ordinary day at Philani Clinic in Komani in the Eastern Cape. Near the clinic entrance, a gogo is helped out of a taxi—breathing heavily and struggling to walk. As she is wheeled inside the clinic in a wheelchair, other people are sitting around waiting to be helped. They don’t seem to mind the camera and look disinterested when Spotlight approaches them. One says that photographers come and go and none of them or their photos have helped solve their problems with the clinic.
Dilapidated Philani Clinic “not ideal”
Philani Clinic was built by missionaries decades ago. Locals say the original structure has not changed except for the extension that was built in 1999. The original structure is mainly built with mud and brick. The clinic is one of several health facilities in some rural districts of the Eastern Cape that operate in inappropriate and hazardous structures. These are found mostly in Chris Hani, Alfred Nzo, OR Tambo, and Amathole Districts.
Chair of the Philani Clinic Committee, Luyanda Nongemane tells Spotlight the clinic used to be a TB isolation hospital and was later converted into a clinic. In 1999 a small amenity consisting of a waiting area, dispensary, dentist room, and administration area was constructed but 90% of the structure remains as it was.
“The then Health MEC Sicelo Gqobana, during his term from 2010 to 2014, found the clinic to be unsafe for patients and staff. He suggested that the clinic need to be demolished and the new clinic be built. We even identified the site for a new clinic, but nothing has happened. The government is dragging its feet to respond to our cries,” says Nongemane.
Nongemane says the most pressing concern for residents is the small size of the clinic and the dilapidated building. “This old structure was announced as an Ideal Clinic, funny enough. It is not even qualified to be a Community Health Centre. This is not a 24-hour clinic. There is no X-ray [equipment] and maternity ward. People who need those services need to go to Frontier Provincial Hospital, but we have an Ideal Clinic according to our government,” Nongemana says.
According to the Ideal Clinic Definition and Components Booklet of 2015, an Ideal Clinic is defined as a clinic with good infrastructure, adequate staff, adequate medicine and supplies, good administrative processes, and sufficient adequate bulk supplies, among others. This Ideal Clinic status will be a prerequisite for facilities to register as service providers under south Africa’s proposed National Health Insurance (NHI) system.
In her 2021/22 budget speech Eastern Cape Health MEC Nomakhosazana Meth said by the end of the third quarter of 2020/21, “the current cumulative number of clinics that achieved ideal clinic status since the start of the Ideal Clinic program in 2015, is 48% (370 facilities)”.
One healthcare user at Philani Clinic, Achuma Witbooi, says the clinic needs urgent attention.
“In fact, we need a new building because this structure cannot be refurbished. There are cracks all over the consultation rooms and people who are visiting this clinic are forced to wait outside the premises until it’s their turn to be served.” He says this waiting outside has been happening since before COVID-19.
“The most concerning thing is the long grass that is not maintained. We are on high alert as we fear the snakes. We don’t have anything else besides this clinic that is offering limited services. We were once promised several years ago that the clinic would be upgraded and would operate 24 hours a day since we don’t have anywhere to go at night,” Witbooi says.
With Spotlight’s visit cracked walls, peeling paint, and long uncut grass welcomed healthcare users. Nongemane says they receive many complaints that when it rains, the water seeps through the cracks, causing damp walls.
According to a structural engineer, Mahlatse Nkgoeng these mud structures were built once and expected to last a lifetime. “They don’t. It is not meant to last a lifetime without proper maintenance and strengthening of the structures, so it is inevitable that it will fall apart,” he says. Nkgoeng says, however, today there are benefits to using this construction method if it’s regulated properly on how to construct them safely. “It is environmentally friendly, the materials are readily available and it is a great way of building if it is maintained properly.”
Grateful, but praying
For some residents of Ilinge in the same district, however, their clinic is “a blessing from God” and despite similar challenges, they say it’s their only hope.
One healthcare user, Nontobeko Buthelezi (74), who is a regular at Ilinge Clinic says, “This clinic is our only hope and it has withstood the test of time but it is high time that the government must intervene. It looks beautiful outside, but if you go inside, there are structural challenges such as cracks and it is very small,” Buthelezi says. “It is concerning because we don’t see officials from the department bothering to come and address our basic needs. This place is depressing. I believe proper healthcare should be complemented by [a] proper premises that are regularly maintained.
“Yes, we have a clinic and we appreciate it, but it is high time that our clinic gets some intervention. Nurses are doing their best to give us the best treatment, she says, “but our main concern is the size and standard of our clinic. We are always praying that a storm must not hit our village, otherwise, we will be left with nothing.”
During a press briefing in August 2020, Eastern Cape Premier Oscar Mabuyane acknowledged the poor conditions at some healthcare facilities in the province.
In her 2020/21 budget speech, former Health MEC Sindiswa Gomba vowed that mud clinics would be a thing of the past in the Chris Hani District. Both clinics – Philani and Ilinge are in this district.
She promised that the provincial health department will deliver on the planned infrastructure projects over the 2020 medium-term expenditure framework (MTEF). Also acknowledging that the dilapidating health facility infrastructure is a concern, she said that the refurbishment of infrastructure challenges will not happen overnight.
However, her successor, Meth in her 2021/2022 budget speech, dampened expectations when she said due to limited financial resources, the focus will be on only maintaining existing infrastructure, rather than taking on new building projects.
Infrastructure projects underway
When Spotlight put these concerns to the acting provincial health spokesperson, Yonela Dekeda she said the department assessed its various infrastructure across the province and identified six facilities constructed with elements of mud. “These facilities have been included in the 3-year infrastructure plan [and] include Tsomo Clinic (OR Tambo District), Ilinge Clinic, Lower Didimane Clinic, Philani Clinic (Komani), Molteno Town Clinic (Chris Hani District), and Balfour Clinic (Amathole District).”
Dekeda says the Ilinge and Philani Clinics form part of 60 Community Health facilities and clinics that will undergo replacements, renovations, refurbishments, alterations, and additions over the MTEF. “The scope of the project at Ilinge Clinic and Philani includes major alterations and additions to the existing facility in terms of the Ideal Clinic guidelines and the start of construction is earmarked to start in the 2023/2024 financial year.”
Asked why it has been almost three decades since the mud structures had been there and why it took this long to address the challenge, she said, “The department inherited an aged infrastructure some of which had been initially built as churches or schools and not meeting the correct health standards and building regulations. This has created a heavy infrastructure backlog of R25bn over the 10 years. These facilities also form part of seven hospitals, including Nessie Knight Hospital, that the department identified and included in the Infrastructure Improvements Plans over the MTEF.”
Dekeda said R1.4 billion has been budgeted for infrastructural improvement, including the construction of new assets, maintenance, and health technology.
“For cutting of grass at clinics, the budget for maintenance is decentralised to the eight health districts, and the management, together with their supply chain management units, are responsible for employing service providers to cut grass,” she says.
Meanwhile, the Democratic Alliance (DA) in the Eastern Cape says the department of health is daydreaming when they say they will replace some mud clinics.
DA Member of the Eastern Cape Legislature Jane Cowley says the fact that there are still mud clinics “is indicative of a department that is out of touch with the reality of people’s experience in the rural areas”. “The fact that there are still mud clinics is an absolute travesty because you can see clearly that the infrastructure budget has been poorly managed. There are so many clinics that could have been built with the infrastructure budget.”
Cowley says infrastructure development has no place in the health department but should be under the Department of Public works.
“The department of public works did a far better job than the department of health in building COVID-19 units during the first and second wave. The 10-year user asset management plan by the department of health is a dream that won’t happen based on their financial situation. The department has already spent R5 billion of what they are going to get on 1 April (the beginning of the new financial year) so how are they going to allocate money for the building? The department needs a huge, big spring-clean that goes as far as including the Special Investigating Unit (SIU) to investigate exactly what is going on in infrastructure programmes in the department of health,” says Cowley.