#Vote4Health: No road to health in the Northern Cape

By Anso Thom, Marcus Low, Nomatter Ndebele and Thom Pierce (photographs)

Calvinia, Sutherland, Fraserburg, De Aar, Keimoes, Kakamas. Join Spotlight on a disturbing road-trip through the Northern Cape public healthcare system.

In November 2018 Spotlight travelled through the Northern Cape meeting with doctors, nurses, activists, politicians and community members. After months of follow-up and attempts to get comment from government, we have decided to publish the disturbing information we have. Below are some reflections on six towns we visited – also see our more in-depth feature on the Northern Cape here.

 Calvinia

Road works: Somewhere along the road between Calvinia and Sutherland.

In November last year this town had two Community Service doctors only. It now has three Community Service doctors, a Congolese-qualified doctor and two private GPs doing sessional work in the hospital. One of the Community Service doctors now travel to Sutherland once every two weeks for a few hours, with no supervision.

Sutherland

Desolation: The road out of Sutherland

Sutherland has no doctors after the last state doctor left at the end of November. A professional nurse Marguerite Jordaan who recently retired after 29 years in the service said it has been extremely challenging to deliver a 24 hour service at the 24 bed Community Health Centre which includes an eight bed maternity unit. What does she do when she has a serious case and there is no ambulance or doctor? “You pray a lot,” she smiles. “You do what you can and you hope for the best.” The Community Health Centre relies heavily on the nearby Southern African Large Telescope (SALT) operation to sponsor crucial basic medical supplies such as bandages, syringes, suture material and plasters.

Fraserburg

Health workers often have to travel the 100km plus dirt road between Sutherland and Fraserburg, a road that notoriously destroys vehicles.

About 110km on a corrugated dirt road east of Sutherland, Fraserburg also has no doctor and reports of several nursing staff simply not pitching for work on some days. A nurse told Spotlight that referring patients to hospitals was a massive challenge with ambulances often forced to transport up to eight patients to Calvinia or Upington. She recalls instances where Calvinia could not take on any surgical cases as they had no gauze. The nurse also said there has been times when the depot in Kimberley had no insulin and no drugs for epilepsy.

De Aar

De Aar: Shiny, new and deserted.

Both the outside and inside of The De Aar hospital building looks like a shiny pamphlet. The hedges that line the drive ways are trimmed, the signs on the hospital are gleaming in the afternoon light, the security guards at the gate are many, there isn’t any litter in sight- just paved walkways and seemingly unused red benches.

About a year ago, the old De Aar hospital was suddenly closed and almost overnight, the entire hospital was moved a few kilometres down the road to the new facility.

The old facility is now an empty lot, guarded day and night by two security guards.

Over five or six months, thieves have looted the hospital of what furniture was left. Pieces of the ceiling have been ripped out, corrugated iron roofing and other equipment ripped from the walls. Everything that is possibly worth anything has been removed.

The corridors are littered with patients files, sealed syringes, used syringes, medication packets, floppy computer discs, and other debris. Some say that the old hospital was supposed to be turned into a nurse’s home, but that the delay meant the thieves could take what they wanted.

Now De Aar, famous for being home to one of the country’s most important railway junctions, is home to what appears to be two mostly empty facilities, and a story that just doesn’t add up. 

Keimoes

Keimoes hospital: Not much of a health facility

It does not really matter from which side you approach Keimoes, chances are you would have negotiated some serious dusty desert to reach the heart of the so-called Green Kalahari, an oasis resting lazily on the banks of the Orange River, also known as the Gariep. Fat, thick vines are luminous green with irrigated water glistening in the sun. The surroundings are bone dry, but the Gariep pumps more than enough of the lifegiving fluid to grow the best export sultanas as well as tons of wine grapes, pecan nuts, watermelons, peaches and lucerne. The manicured farm entrances all speak of prosperity, lush Bougainvillea and Cannas showing off several rainbow colours. Everything seems to grow and prosper and shine.

But scratch a little so you can see below the green, and the tranquil, almost fairytale-like picture dissolves. Driving towards Kakamas, the hospital sits on the edge of the town, in a dustier section of Keimoes off the main road. The brick building is tucked away towards the back of a large dusty yard and there is almost no human activity. There is also no security or a manned gate. A walk around the hospital’s exterior presents flung open doors with empty rooms filled with rubbish and waste, rubbish has also been dumped in the veld a few steps from the hospital and the morgue is behind rickety lock and key, no longer in use.

The health services inside the hospital appears to be in a similar state, despite the best efforts by those who bother to pitch up for work. Most parts of the hospital are deserted with some signs of its former heyday… “hospital” is actually not the correct term or even more correctly, Community Health Centre. There is no doctor. There are very few other health workers or staff such as cleaners. Community members speak of constant shortages of medicines and basic supplies such as bandages. Ambulances are glorified taxis between the hospital and Upington about 45km away. Two nurses and their assistants try to keep the 28-bed hospital running. Patients, admitted to the beds (including the six-bed “maternity” ward) are left to fend for themselves. A health worker who spoke to Spotlight admitted openly that they mostly have to ask family members to bath and feed patients. As we walk down a particular passage, the moaning from one of the rooms leads to a man lying on his side, staring into space, groaning in pain with no health worker to attend to him. In another room a young mother watches every breath from her baby in the cot. Further down another passage just past the room where women give birth, a chest freezer reveals buckets with human tissue. Read more in the main article.

In another wing, patients wait in the hospital’s now former theatre (the overhead lights are a giveaway), as the nurses try to get through the waiting queue. This is not a hospital, it is barely a health facility. The people of Keimoes deserve better.

(Spotlight visited an ambulance base in at the hospital which is basically a rundown little office with collapsing ceiling and electrical extensions running across the floor. A manager who spoke to Spotlight admitted that “the ambulances are more broken down than running”.

  • A list of questions were sent to the MEC and the Northern Cape health department with specific questions on the state of Keimoes hospital. None were responded to.

 Kakamas

Alternative view: The outside of Augrabies Clinic near Kakamas.

From the outside Kakamas hospital is picture perfect. The image of the hospital is delicate, so delicate that if one looks a little bit harder. The hospital starts to unravel, from the inside out. There are session doctors in the hospital, but the theatre has been locked for years. There are doctors, but there are no oxygen tanks. Staff tell us there are no IV drips and very little drugs and other medical supplies.

They tell us that nepotism is rife, that friends are appointed into senior positions with no qualifications, that HR functions are a joke. Community activists, hospital staff and NGO workers spoke openly about the dysfunctional state of the hospital. “There is corruption everywhere” says NGO worker Caroline Booysen, “The only people that get help here are relatives or friends,” she said.

We are led down a green passage, with yellow doors alongside it, at the end of the passage are two doors, with the words “Theatre”  painted on a panel above the door. At first glance, all seems well until you notice the big golden padlock dangling on a latch. The theatre is closed. And has been so for months.

 

 

 

#FootSoldiers: The Environment is everything

Environmental activist Thomas Mnguni. Photo by Thom Pierce

Fourty-five-year-old Thomas Mnguni was born and raised in Middleburg Mpumalanga. He has lived his entire life in what the government considers a priority zone in terms of air pollution, which means that there are very high levels of pollution in the area. The priority zone covers the Gert Sibande District, Nkangala and Ekhuruleni.

Thomas has always been a community activist, he speaks casually about being arrested at a community protest a few years ago, where the community was protesting about the renaming of the local municipality from Middelburg to Steve Tshwete and advocating for community members to be employed in projects that were being set up or created for the community. “I’ve always been an activist, but when I found environmental justice activists, I knew that’s what I should be doing,” he said.  And when Groundwork (an environmental justice NGO) offered him a job in 2015, Thomas had finally met his match.

By the time Thomas was employed by Groundwork he had already accumulated a wealth of knowledge from previously volunteering at Environmental justice, another environmental NGO.  He learned from fellow activists and his quest  for knowledge led him to section 24 of  the Constitution of South Africa, which he now recites confidently. “ 24A Everybody has the right to an environment that is not harmful to their health or well-being.” Armed with the constitution and his knowledge of the environment, Thomas decided to get into communities and make them aware that their rights are being violated and that there were rules and laws that protect them from such violations.

A few years later, Thomas’ four year old son, developed chronic flu, the family did not make too much of it. Thomas’ mother then said that this was not normal, and that the child had to be taken to see a doctor. The doctor told Thomas that his son was displaying signs of asthma. Considering what he knew about pollution from his activism,  Thomas decided his family had to move away. The place they were staying in was very close to two mines and a landfill.  A few months after the move, Thomas’ sons asthma became more manageable.

After this experience, Thomas was more determined in his activism. He wanted to inform communities, empower them and assist them in mobilizing themselves to start to demand that the government protect their environment and in doing so, protect their health.

“The thing about environmental justice is that it is politics and it  cuts across all spheres of society, it’s about health, it’s about housing, it’s not just about the environment,” says Thomas.

  • Foot soldiers of the health system: It’s election time which means men and women in party regalia take to the streets, podiums, loudhailers and stadiums. Invariably they tell people about all the good and wonderful things they have done or plan to do in the health system. SECTION27’s Nomatter Ndebele and photojournalist Thom Pierce travelled the roads of South Africa in search of the foot soldiers of the health system, the men and women who quietly get on with doing the job and saving lives, often without any acknowledgement.

 

#Vote4Health: Health in the Northern Cape: Disturbing visions from SA’s forgotten province

Helping hand: An elderly man is helped through the streets of Prieska in his wheelchair. All Photos by Thom Pierce

By Anso Thom, Marcus Low, Nomatter Ndebele and Thom Pierce (all photographs)

Health services in large parts of the Northern Cape have virtually collapsed with communities mostly being served by overstretched nurses struggling to cope with the disease and injury burden. The challenges are overwhelming. Qualified doctors, specialists and professional nurses are as scarce as water in this arid province. Health facilities are poorly serviced with basic services such as emergency medical services, cleaning and infection control, drug and basic medical supply stocks, mortuaries, standard operating hours, trauma and mental health services virtually non-existent in most towns.

A chest freezer at Keimoes Hospital containing human tissue. In the background an incubator.

In a particularly shocking instance Spotlight was shown frozen, bloody medical waste in a chest freezer which was by all accounts tissue from abortions or stillbirths. Keimoes Hospital mortuary is locked up and abandoned. Instead community members and some health workers told us that bodies are collected by a nearby undertaker who then in turn negotiates the funeral or transport arrangements with families. On a walkabout through the hospital Spotlight was taken into a room a few steps from the bare maternity ward where a household chest freezer contained buckets of bloody tissue leftover from abortions and/or stillbirths. “Keimoes Hospital” forms to report “nie leefbare fetus (non-living foetus)” were openly displayed on a table next to the freezer detailing the birth mother’s name, contact details, weight of the “fetus” and signature of a nurse and two witnesses. Dates on the forms indicated that the tissue had been in the freezer for some weeks.

But we are getting ahead of ourselves.

Concerning reports from whistle-blowers meant that the Northern Cape had long been on Spotlight’s to do list. Late in 2018 a team of writers and a photographer finally took on the long roads of the country’s largest, but most sparsely populated province. The Northern Cape mostly operates under the radar, but once you pull the curtain back the picture is grim.

Road to somewhere: The R356 that winds through the Northern Cape desert between Sutherland and Fraserburg.

We travelled a circular route through the province and clocked up about 2 000 kilometres of mostly dirt and some tar road visiting doctors, healthcare workers, patients and some of the very few activists in the province. We passed through towns and small outposts, some just blips on the radar long past their heyday. Signposts hinting at suffering whizz by – Sweetfontein (Perspiration Fountain), Omdraaisvlei (Turnback Vlei), Uitlvlug (Flee Away) and so on. We slowed and at times paused in Middelpos, Sutherland, Fraserburg, Loxton, Victoria West, Britstown, De Aar, Prieska, Groblershoop, Upington, Keimoes, Kakamas, Kenhardt, Brandvlei, Calvinia and Nieuwoudtville.

Going home: This man was dropped next to the road by ambulance and left to walk a few kilometres to his home in 30 deg C. He still had a raw wound from major abdominal surgery. 

In the months since the trip we have maintained contact with the many people we met on the road. We have given the Northern Cape government the benefit of the doubt and tried time and time again to show us what they are doing to address the shocking dysfunction in the province. As we explain later on, government has been less than forthcoming.

Based on what we’ve seen ourselves and what we have been told by various sources, we feel confident in making the following 10-point diagnosis of the public healthcare system in the Northern Cape.

  1. There are critical doctor and nurse shortages in the province
Waiting for healthcare at Augrabies Health Care Clinic outside Kakamas.

Almost all the hospitals or health facilities visited by Spotlight had no doctors or were in the process of losing the doctors they had. Calvinia had two community service doctors working without supervision (they now have three community service doctors, two sessional doctors in private practice and one Congolese-qualified doctor), Sutherland and surrounding areas were set to be without a doctor by the end of 2018 (a recent update confirmed that Sutherland has no doctor and was being served by a community service doctor from Calvinia for a few hours every second week), De Aar reportedly had a few doctors – most of them foreign qualified (a visit to the new hospital revealed that the trauma unit was being run by nurses-only), Kakamas had no state doctors and Keimoes had no state doctors. Most community service doctors also work without any supervision.

We spoke to one doctor and one experienced nurse who quit their jobs because of the difficult working conditions and lack of support in the province. According to these two healthcare workers, the provincial department of health made no effort to convince them to stay – in fact, the impression was created that those who ask too many questions would be worked out of the system.

  1. There are often no ambulances to deal with emergencies
No Ambulance: Waiting for healthcare at Augrabies Health Care Clinic outside Kakamas.

Emergency Medical Services are virtually non-existent in some areas in the Northern Cape with the few ambulances that were still in running order mostly used to ferry patients to Upington and Kimberley. One ambulance manager reported that very few ambulances were on the road with the bulk of the vehicles not being in running order. Spotlight was also told that most of the ambulances are run by Basic Life Support staff and that there are literally just a handful of Intermediate or Advance Life Support paramedics in the entire province. We spoke to one mother who lost her baby – possibly due to the fact that an ambulance was not available to transport her from Keimoes to Upington.

There are also serious questions around the awarding of the aeromedical ambulance service contract in the Northern Cape which has gone to a company that by all accounts failed to conduct outreach services in the province when it had the previous contract. For many years such aeromedical outreach programmes were an effective way to get specialist care to various outposts in South Africa’s largest province

  1. The Northern Cape is a province of ghost hospitals
Deceiving looks: De Aar’s new hospital, but by all accounts not too much happening on the inside.

Many “hospitals” in the Northern Cape have been downgraded to Community Health Centres, which is just a fancy term for hospitals with no doctors. In Kakamas and Keimoes nurses are left to run “Community Health Centres” with overnight beds…family members and friends are asked to look after patients in the overnight beds as nurses try to work through the queues in the outpatient departments.

When Spotlight visited the brand new De Aar hospital it felt like an empty shell with only a few wards operational. During the 7pm shift change Spotlight also observed very few health workers arriving and few leaving for such a big hospital. We were told the TB ward is still not open with no beds – we were also told that the TB ward was one of the reasons why the new hospital was built in the first place. Democratic Alliance counsellor Kobus Rust told Spotlight they were aware of the new hospital often having no hot water, a massive shortage of critical staff, posts not filled as disciplinary processes dragged on for very long, ambulance services not functioning, cash flow problems and poor workmanship at the new site. Rust claimed there was also no functioning TB facility in the province and that political interference was hampering service delivery.

  1. The province has a problem with vacancies and political appointments in the healthcare system
Keimoes: Nurses are struggling to cope with looking after patients in beds and those waiting in the Outpatients department. There are no doctors.

The Northern Cape public healthcare system has large numbers of vacancies with very little evidence that there have been serious attempts to attract qualified people. Instead the province places “block ads” which means they on a few occasions invite people to send their CVs to head office which are then placed on file. Spotlight was given information of administrative appointments made based on political affiliations and people without the proper qualifications being appointed or administrators being appointed at facilities without there being vacancies or communication with facility managers. We put some of these allegations to the province – they did not respond.

5. There are question marks over the appointment of the Head of Department

Many questionmarks and questions: Northern Cape Head of Department Stephen Jonkers (file photo)

The appointment of the Head of the Northern Cape Department of Health Dr Steven Jonkers is mired in controversy. The province failed to produce the advertisement for the job when asked. Media reports indicate that Jonkers received a “golden handshake” in 2016 from the Northern Cape Department of Transport. At the time of his appointment to the health department Jonkers was reportedly facing charges of corruption. Neither Jonkers nor the Department of Health responded to questions on these allegations. The department also failed to share an organogram of the department with the latest document we could find dating back to 2016/7 only containing the name of the MEC at the top.

6. There are stockouts across the board

Drug shortages: A medicine trolly in Keimoes Hospital.

Health facilities in the Northern Cape regularly face stockouts and shortages of basic medical supplies, drugs, food and stationary. When Spotlight for example visited Kakamas the hospital had among others no intravenous drip bags. Basic infection control was absent in Kakamas with no cleaning services over weekends and cleaners only working from 7am to 12 noon in the week. We received similar reports at a number of other facilities with various different medicines and other essential supplies being reported as being out of stock.

7. The central hospitals are taking strain

Northern Cape Hospitals: Road to nowhere?

A key hospital in the province, Dr Harry Surtie in Upington has severe staff shortages with health workers and patients who spoke to Spotlight claiming the hospital has high death rates. According to news reports the Democratic Nursing Organisation of South Africa late last year downed tools at Harry Surtie mainly due to staff shortages and the fact that it was endangering lives. The Democratic Alliance has also been sharing figures of vacancies in some departments in the hospital claiming that only 228 of 327 hospital beds could be used because of staff shortages.  Patients are fearful of being referred to this hospital saying too many people return home in coffins. Some healthcare workers told us that people go to Upington to die. This could of course be because only the sickest people are sent to Upington, but most people seem convinced there is more to it.

8. Some facilities are downgraded to Community Health Centres, but forced to operate like hospitals

Ward shifting: Some wards are used as officers at Keimoes Hospital.

Keimoes and Kakamas Community Health Centres are buildings posing as health facilities. When Spotlight visited the two health centres it was being run by only a handful of nurses trying to hold the fort, basic medical supplies were out of stock, a long list of drugs were out of stock and some hospital board members were being accused of illegally receiving government tenders. The understaffing and horrible working conditions we saw for ourselves – while we cannot confirm that there is substance to the allegations of corruption, we can confirm that many healthcare workers believe there to be corruption – which is serious in itself.

9. Many primary Health Care clinics are virtually non-operational

Dirty waiting game: Dirty water and waste next to patients waiting at Augrabies Health Care Clinic.

Around Kakamas and Keimoes, several primary healthcare clinics such as Augrabies, Alheit, Marchand and Lutzburg had patients sitting outside when Spotlight went there, waiting for a nurse to arrive, hours after the clinics were supposed to open. Patients spoke of stockouts of basic medicines, having to wait long hours to see a nurse and health workers often not pitching. Mothers with newborns said they were also turned away to return at a later date for immunisations.

10. The Northern Cape government couldn’t care less about accountability

No accountability: Almost none of the clinics Spotlight visited operated in accordance with the stated hours. Most of them were not open yet late morning.

There is very little effort by those in power in the Northern Cape to show any accountability. For several months, Spotlight’s efforts to elicit any comment, explanation or meetings with the MEC, her advisor, the head of department or any other people in decisionmaking positions came to nothing. Promises of interviews and meetings came to zero, while all questions or requests via the media office or the HOD’s office were simply ignored. Almost 70 questions were sent to the MEC, the HOD and the head of Communications at end of 2018. These questions were resent in early 2019 with several follow-ups. There was no effort to engage or answer the questions other than the MECs advisor making some promises regarding a “no holds barred” interview which came to nothing.

Spotlight tried to get comment from the National Department of Health and was told that this was a matter for the health minister. However, we were later informed that the Minister was not able to comment as he had been busy with elections.

The Democratic Alliance in the province also expressed interest in commenting and said they had lots to say, but later indicated they were also busy preparing for the elections.

For many in the Northern Cape, once the razzmatazz of the elections has come and gone, their living hell will continue.

  • Below we include the full list of questions we sent the Northern Cape Department of Health including the MEC, the HOD, the MEC’s advisor and the head of Communications. As explained above, the Department undertook to answer the questions, but never did so despite repeated extensions and reminders. These questions were also shared with the National Department of Health in February. They have also failed to comment.

Please provide us with answers to the below questions no later than close of business on 6 December 2018. We have visited a number of healthcare facilities in the province and interviewed a wide range of people. With the below questions we are giving the NC DoH an opportunity to respond to many of the very serious issues we have picked up. Should the department fail to respond by the given deadline we will go to press with the information we have at our disposal and state that the department declined to comment. We recognise that this is a long list of questions – which is why we are providing more than a week for the department to comment.

General Human Resources

  1. Can you supply us with a logsheet of advertisements for vacancies in the health system over the past 12 months? If you are not able to do so, can you please indicate where you have advertised posts over the past two years.
  2. Can you confirm that the province mostly relies on “block ads” where you put out a general call for CVs, place those on file and select CVs when you have vacancies.
  3. Does the province struggle to recruit and retain healthcare workers such as nurses, doctors and specialists? Please explain.
  4. How are admin clerks recruited and placed in clinics? Is this done in consultation with the facilities where they will be placed?
  5. What steps has the department taken to avoid appointments in the province’s healthcare system being made on the basis of political affiliations?
  6. What is the vacancy rates in your funded posts for nurses, doctors and specialists?
  7. Please supply a breakdown of full-time doctors, specialists and nurses employed by the province and which facilities they are placed?
  8. How many doctors and specialists are RWOPS? How is this monitored to limit abuse?
  9. Are there any ComServ doctors in the province who are working without the required supervision?
  10. Can you please supply us with the copy of the advertisement for the current Head of Department?
  11. Can you confirm and explain why at least 28 admin clerks were appointed in Namakwa District facilities shortly after the local government elections?
  12. Can you confirm that most facilities were not informed of these appointments?
  13. Are you aware of reports that the current HOD Dr Steven Jonkers received a “golden handshake” in 2016 from his former employer, the Department of Transport before he was appointed to the health department? Were you aware of the pending charges of fraud and corruption at the time of his appointment? Has this investigation been completed and has the Department or Transport been able to provide an update on these charges and the investigation to the Department of Health?
  14. Can you please share the current organisational structure of the Northern Cape health department? We note the one we were able to access from the 2016/7 annual report only has the name of the MEC.
  15. Are there instances where people are appointed without any job interviews conducted?
  16. Are line managers involved in recruitment or is it all done centrally?
  17. Can you confirm how many foreign qualified doctors are employed by the NCape DOH? How many qualified in Cuba?
  18. Does the NCape DOH currently have a doctor or nurse employed in a facility with a track record of substance abuse? Including a criminal record?
  19. Does the NCape DOH have a website? What is the address?
  20. Has there been a circular to staff informing them of the name change of Kimberley Hospital to Robert Sobukwe Hospital? Please can you share it?
  21. Have HIV Counsellors in facilities been trained in the last 12 months? Please share details?
  22. How many EMS personnel are employed that are higher than BLS? Please give breakdown between ILS and ALS?
  23. Please comment on reports that most facilities face regular stockouts of basic drugs, medical supplies, food and stationary?
  24. How many psychiatrists are employed full-time by the NCape health department?

Hospitals

  1. Please comment on reports that Dr Harry Surtie Hospital in Upington is suffering from severe staff shortages? Please share relevant details.
  2. Please comment on reports that Dr Harry Surtie Hospital has high death rates and that many patients are fearful of being referred to this hospital as many people die?
  3. Can you confirm that Calvinia hospital has only two Community Service doctors who work unsupervised? If this is not correct, please explain what the arrangement is?
  4. Please can you supply an update on the Psychiatric Hospital in Kimberley? When will it open, what the reason for the delay is, etc?
  5. Please can you supply details on what the old De Aar hospital buildings and land will be used for?
  6. Were the old De Aar hospital buildings gutted with the approval of the health department? If yes, who was the contract given to and how much was paid to the department?
  7. How much is being paid to station security guards at the gate at the old De Aar Hospital?
  8. Is there a plan to clean up the medical waste still on the grounds at the old De Aar hospital?
  9. Please confirm how many doctors, specialists and nurses are employed at the new De Aar hospital?
  10. How much money is paid for security at this hospital?
  11. Please give a breakdown of the specialists employed at De Aar and whether they are full-time?
  12. Please confirm that the casualty ward is run by nurses?
  13. How many beds does the new De Aar Hospital have and how many of these beds are open and being used?
  14. How many wards are not being used at the new De Aar hospital?
  15. Please confirm that the TB Ward at the new De Aar hospital remains closed?
  16. Is there a shortage of staff at De Aar Hospital?
  17. Please confirm that the doctor stationed at Sutherland has resigned and that this means Sutherland and Fraserburg clinics will be without a doctor? Please also indicate what steps were taken to keep this doctor?
  18. Please confirm that Sutherland clinic often operates without professional nurses who have to be on standby?
  19. Do Sutherland or Fraserburg have any persistent stockouts of drugs of medical supplies?
  20. When was Keimoes Hospital changed to a CHC? Why did this happen?
  21. Please confirm that Keimoes still has 30 beds?
  22. Please confirm that the casualty ward at Keimoes is run by nurses? Are these professional nurses?
  23. Keimoes does not have a mortuary. What does the hospital do with deceased patients?
  24. What does Keimoes Hospital do with aborted foetuses or stillbirths and what are the timelines related to these processes?
  25. Please confirm that there is often only one ambulance operating from Keimoes?
  26. Please confirm that the vast majority of ambulances are often not operational and in for repairs?
  27. Please confirm that the ambulances are often used as patient transport vehicles transporting more than one patient to Upington?
  28. Please supply a breakdown of ALS, BLS and ILS paramedics working from Keimoes.
  29. We understand that the province has put out a new tender for an air ambulance service. What will this service do?
  30. Have you received any complaints regarding the Kakamas Hospital CEO?
  31. Does Kakamas Hospital have any full-time doctors?
  32. Who fulfils the HR function at Kakamas Hospital? Is it the hospital administrator? Have her qualifications to be in this post been confirmed?
  33. Are you aware that multiple members of the same family are employed at Kakamas hospital and other health facilities in Kakamas?
  34. Can you confirm that the Kakamas hospital cleaners only work in the mornings and not over weekends?
  35. Please supply a list of drug and medical supply stockouts at Kakamas and Keimoes hospitals?
  36. Does Kakamas have supplies to administer IV drips?
  37. Are you aware of any irregularities regarding the constitution of the Kakamas hospital board?
  38. Are any members of the Kakamas hospital board involved in companies that are in business with the Department of Health in the province.
  39. Please supply the operating hours of Augrabies, Alheit, Marchand and Lutzburg Clinics? What time do nurses start consulting patients?
  40. Does each clinic have a dedicated nurse?
  41. Do these clinics have stockouts of medical supplies and drugs?
  42. Is the province satisfied that patients enjoy privacy while being consulted by a nurse?
  43. Do TB patients received their treatment at the backdoors of some clinics?

 

 

#Vote4Health: Visuals of Northern Cape collapse

Health services in large parts of the Northern Cape have virtually collapsed with communities mostly being served by overstretched nurses struggling to cope with the disease and injury burden. The challenges are overwhelming. Qualified doctors, specialists and professional nurses are as scarce as water in this arid province. Health facilities are poorly serviced with basic services such as emergency medical services, cleaning and infection control, drug and basic medical supply stocks, mortuaries, standard operating hours, trauma and mental health services virtually non-existent in most towns. Last November Spotlight travelled a circular route through the province and clocked up about 2 000 kilometres of dirt and tar road. We passed through towns and small outposts, some just blips on the radar long past their heyday. Signposts hinting at suffering whizz by – Sweetfontein (Perspiration Fountain), Omdraaisvlei (Turnback Vlei), Uitlvlug (Flee Away) and so on. We slowed and at times paused in Middelpos, Sutherland, Fraserburg, Loxton, Victoria West, Britstown, De Aar, Prieska, Groblershoop, Upington, Keimoes, Kakamas, Kenhardt, Brandvlei, Calvinia and Nieuwoudtville..

There are many stories to tell and many issues to highlight which we try to do in our main story. However, there are many images to share. Thom Pierce joined the team and captured a collection of images that try to tell a visual story of this arid, beautiful, suffering province.

Dare to care: Retired nurse Marguerite Jordaan on her farm Matjiesfontein, about 32km outside Sutherland.
Desolation: The road out of Sutherland
Horror story: Nigel October is a pump attendant at Sutherland’s only filling station. Like most residents he has a horror story to tell of needing emergency care, the hellish trip in the back of ambulance on a dirt road, being sent from Calvinia to Worcester and then back to Laingsburg where he is told to find his own way home. “Ambualances just dump patients and you have to find your own way,” he says. “At the clinic they sometimes treat us like animals, not like humans.”

 

Death and dying: Family graveyards are a regular sighting on the farm roads. Closer inspection often reveals infant graves, hints of inaccessible healthcare way back. This one was on the road between Middelpos and Sutherland.
Round and round: Wind pumps dot in the vast emptiness of the Northern Cape.
Neverending: The R356 that winds through the Northern Cape desert between Sutherland and Fraserburg. Session doctors and ambulances have to travel this road.
Road to somewhere: The R356 that winds through the Northern Cape desert between Sutherland and Fraserburg.
Dodgy health: Fraserburg Community Health Centre.
Dead and buried: Hundreds of stones mark unnamed graves as you pass Prieska.
Looting: At the old hospital in De Aar the buildings have been torn apart and the roof panels stolen.
Free for all: The wreckage of the old hospital in De Aar which has been ransacked.
Shiny and new: Bespoke signage for the new De Aar Hospital.
Road to health: The walkway leading to the entrance of the new De Aar hospital, complete with bespoke pillars and an irrigation system.
Inside and out: The outside of the new De Aar hospital has been designed with modern benches and walkways.
Land for health: Land that is still to be developed – the overgrown site for the next phase of the already over specced De Aar hospital.
Neverending: The road between De Aar and Prieska.
Helping hand: An elderly man is helped through the streets of Prieska in his wheelchair.
Road to nowhere: The long, straight road leaving Prieska.
Going home: This man was dropped next to the road by ambulance and left to walk a few kilometres to his home in 30 deg C. He still had a raw wound from major abdominal surgery.
Augrabies Health Care Clinic. One of the small town clinics outside Kakamas, where patients wait on the floor for the nurses to arrive.
Waiting for healthcare.: Mothers and their children outside the Augrabies Health Care Clinic near Kakamas.
Mothers and children, waiting all morning for healthcare. Augrabies Health Care Clinic outside Kakamas.
Dirty water and waste next to patients waiting at Augrabies Health Care Clinic
Dirty waiting game: Dirty water and waste next to patients waiting at Augrabies Health Care Clinic.
Waiting for healthcare at Augrabies Health Care Clinic outside Kakamas.
No Ambulance: Waiting for healthcare at Augrabies Health Care Clinic outside Kakamas.
An informal rubbish dump just outside of the Augrabies Healthcare Clinic.
The lush vines of the the grape producing vineyards outside Augrabies. Some of the world’s best table grapes and raisins come from this region.
No accountability: Almost none of the clinics Spotlight visited operated in accordance with the stated hours. Most of them were not open yet late morning. This is Marchand Clinic. No nurse was there when Spotlight went.
Waiting outside Alheit Primary Health Care Clinic. No nurse in sight.
Debris and waste at Keimoes hospital.
A bathroom inside Keimoes hospital, allowed to fall into disrepair.
Toilets are now used as storerooms in Keimoes Hospital.
Bio-hazard waste is left unsealed and unattended at Keimoes Hospital.
A mother watches over her sick newborn at Keimoes Hospital.
Behind another unlocked door we find cylinders and biohazard disposal units.
The locked and deserted mortuary at Keimoes hospital.

#FootSoldiers: Umsebenzi wama CHWs – Bringing hope and life to the community of Sweetwaters

Foot soldiers of the health system: It’s election time which means men and women in party regalia take to the streets, podiums, loudhailers and stadiums. Invariably they tell people about all the good and wonderful things they have done or plan to do in the health system. SECTION27’s Nomatter Ndebele and photojournalist Thom Pierce travelled the roads of South Africa in search of the foot soldiers of the health system, the men and women who quietly get on with doing the job and saving lives, often without any acknowledgement.

A story of life and death, of love and compassion. Of caring. Gogo Tholana and Doris Ntuli. Photo by Thom PIerce

Umsebenzi wama CHW. (The work of CHW’s) – Bringing hope and life to the community of Sweetwaters

Three years ago Doris Ntuli and her fellow Community Healthcare Workers (CHWs) Nhlanhla Makhaya and Sindi Zondi took Spotlight from house to house on a tour of Sweetwaters  in KwaZulu-Natal where the trio worked for a paltry R1 800 per month,  caring for extremely ill people in their homes. They had no resources, which means they had no gloves, no soap, no bandages, and no support from those in power. At the time Spotlight published an iconic photograph of CHWs using old bread bags as gloves as they washed patients at home. Last week Spotlight returned to Sweetwaters and found the trio.

The last time we saw  78-year-old Gogo Tholana in July 2016, she was living alone in a bare rondavel in the hills of Sweetwaters. She had been ill for two years, suffering from a serious and possibly fatal kidney infection.  She was bed ridden, her skin was ashen, she was stick thin and was wearing nappies. When she spoke she was almost inaudible, and was barely able to sit up. Day in and day out, she lay on a thin mattress in her rondavel, a few meters away from a fire place. Her only source of heat in the rondavel. She would have to wait until Doris Ntuli or another CHW came to check on her, to ask them to light a fire for her.

This time, almost three years to the day we met Gogo Tholana, we are led a little bit further down the hill, her rondavel is still there, but there is a gold latch dangling on the door. A few hundred meters from the rondavel is a big four-roomed house, and in bedroom number two (all the doors are numbered) we hear a loud voice saying “ Ah, you’re here”. We wait while the CHWs enter the room 2, and now there are sounds of laughter and excitement emanating from it.

Doris Ntuli and her fellow Community Healthcare Workers (CHWs) Nhlanhla Makhaya and Sindi Zondi with Gogo Tholana in the blue gown. Photo by Thom Pierce.

The trio of CHWs file out of the room, with a sparkle in their eyes and finally a large ever present woman, dressed in a baby blue gown stands up straight in the doorway.

The person standing in the door way is a healthy weight, her skin is bright and she has a wide cheeky smile on her face. It is almost unbelievable, that this was the helpless woman lying in a bare rondavel, whose only access to healthcare was through three dedicated CHWs who never missed a single day in attending to her, feeding her, bathing her, clothing her, washing her sheets, washing her clothes and telling her silly jokes to keep her spirits up.

The woman who stands in front of us now, clearly cheated death.

Umsebenzi wa Labantwana ongivusileyo (It is the work of these kids that bought me back),” says Gogo while she points at the three CHWs. My skin was black, I couldn’t move, I tried my best to shuffle across the room to try and relieve myself, but I could not move to urinate, so I had no choice but to urinate on the mattress I was lying on,” she recalls.

From this single example it is clear how Doris Ntuli and her team of CHWs have impacted on lives in the community.  However, on the flipside, sadly very little has changed for the CHWs themselves. Other than a salary increase implemented earlier this year,  shiny name tags, and branded backpacks from the department of health, not much else has changed.

The backpacks cling limply to their backs, as the women make their rounds by foot, visiting the 60 households they look after. There is nothing in the bags  to assist them in doing their work. The CHW’s still don’t have the resources they need, they do not have a transport subsidy, not an airtime subsidy, there are no masks to prevent them from contracting communicable diseases, and often times, they still don’t have gloves to wear. This while they care for patients the public health system no longer cares for in any other way.

“A few months ago, we did a TB program, we walked up and down these hills collecting sputum, with no masks or gloves. We then had to walk a long way to the central point where we had to deliver these (sputum) bottles. So many of our colleagues have died, and many more continue to die from contracting TB and other diseases, as we have no means for infection control,” says Nhlanhla .

In meetings and workshops in roundtables, politicians and health department workers will speak of war rooms and the importance of CHWs, but ask these CHWs and they will tell you that when they report their challenges to the “war room” the only ones who respond is the Department of Agriculture. The departments of health and social development are mostly no shows. Many of the issues the CHWs encounter require the assistance of social workers in order to assist the community in attaining ID documents, grants and food parcels. As it was three years ago, Doris and the team still take food from their own homes to feed their patients.

“The patients will hold their medication in their hands and say, I have no food- How can I take this medication,” says Sindi.

From their salary of R3 500, they must look after their own families, as well as all their patients. “By the time we get paid, the money Is already gone,” said Sindi

“When we arrive at a household, if there are ten people living there, we attend to every single person. We check the elderly for chronic diseases, we ensure that babies in the household have been immunized, we check their growth, and after all the health aspects, we deal with the social issues- some are being abused, most are unemployed, others have no means of accessing a grant- and all of that is on us,” says Sindi .

As they walk along the streets, community members wave,  shouting greetings at them, “Hello Nurse, Hello social worker!”

“That’s what they call us, but our actual titles are just CHW’s,” says Nonhlanhla.  The community has so much faith in the trio, that sometimes the terms of endearment weigh heavily on them, particularly when they are unable to provide the assistance people need. Never  due to a lack of effort on their own part, but rather because the system they are made to work in, provides them with no support. The situation begs the question, why do they bother?

Each of the CHW’s are bound to their work by this inherent need to help. The idea of community and care is one they hold in high regard, “You cannot see trouble next door and just look away,” says Nhlanhla.

For Sindi though, it was the death of her cousin who died from AIDS that lead her to caring for the community. “My cousin was so ill, he bled from everywhere possible, his ears, nose, mouth, he bled from every opening in his body, he never told us what was wrong, he died from the disease, but it was also the way he was treated that killed him. He started to notice that he was being served with the same dish and spoon everyday- we didn’t know better then. But when he died, I vowed to myself that I was never going to let another person die like that, not under my watch”

And so she joined Doris and Nonhlanhla in taking care of the community of Sweetwaters. The trio is unstoppable, there isn’t a hill they won’t climb, not a story they won’t listen to and not a single house they will pass. Unknown to the high ranking officials of the Department of Health, these three woman live and breathe the principals of Batho Pele.

With what little they have, they ensure that the community comes first in every way. And while the country prepares to mark a change with an (x) these foot soldiers are committed to bringing change and hope that is far more tangible, than that of a ballot box.

#Vote4Health: Funding the right to healthcare

2019-IEJ-S27-Health-Fact-Sheet

By Daniel McLaren and Nomatter Ndebele

Despite the Constitutional injunction on the government to ensure that everyone has access to quality health care services, including reproductive health care, and the promise to equalize access through National Health Insurance (NHI), public health care services remain grossly under-funded. Vacant health posts, outdated or sub-standard equipment, medicine stock outs and crumbling public health infrastructure leave millions  of people who rely on the public health system without access to the care they need.

Over the past year, the government has tried to push ahead with implementing the long awaited NHI policy. The idea of providing affordable universal healthcare in a country with such dire inequality is important. However, it is essential to build NHI on a solid foundation. Improving public health facilities up to the performance levels that are necessary requires adequate financing, human resources, organisational capacity, as well as accountability.

Every day, there are stories of people struggling to gain access to healthcare. The narrative of a struggling public health sector is long standing. What is rarely acknowledged by those that vaunt the quality of care in the private system however, is how much money we are throwing at that private system and whether those costs are sustainable.

As a country, we spend a similar amount of money on a private health system that serves only one in five people, as a public system that serves everybody else. In average per person terms, this equates to approximately R4 480 spent on each person who relies on public health care, compared to R17 225 per person who has private medical insurance.

During the fifth democratic administration, spending on social services stalled overall as a result of budget austerity. Additional funding was made subject to cuts in other areas. For example, the injection into higher education was funded in part by cuts to school infrastructure grants, as well as a hike in VAT. In health care, spending by the state increased in real terms by only R255 per public healthcare patient between 2014/15 and 2018/19. Spending per person in the private health sector increased by R1 001 during the same period. This stands in stark contrast to the doubling of spending on public health that is envisaged for the NHI transition.

Our health human resources are also thoroughly unevenly split between private and public care. In 2018, one government employed doctor had to attend to 2 457 patients, while their counterparts in the private healthcare sector only had to see to 571.  This situation is exasperated by the brain drain in the public healthcare sector which is a result of poor management as much as underfunding. But good health care managers are scarce too. In a country where most people depend on the public healthcare system, only 35% of registered nurses and midwives were working in the public sector.

Without adequate financial resources and medical personnel, the public health care system will continue to crumble while people seek greener pastures or better care. Our public health care system needs radical overhaul in order to provide the kind of care that the people who depend on and are entitled to by right.

Corruption in the health care sector became a national concern during the 5th administration as it exacerbates the problems mentioned above – draining and misdirecting precious resources . The arbitration process that followed the Life Esidimeni tragedy found that the need to cut costs was a red-herring excuse used by departmental officials attempting to avoid accountability for their uncaring and unlawful decisions. However, there can be no doubt that such disasters are more likely to occur in an under-resourced health system where health departments are under constant pressure to meet austere (and often arbitrary) Treasury imposed expenditure ceilings, than in one which they have sufficient resources to provide appropriate care according to need.

It is clear we need increased scrutiny when it comes to the financials of the health care sector. It is also clear that we need a government that is committed to translating lofty promises for a better life for all into a programme for system-wide health care reform. Adequate funding also needs to be provided to make improved public health care a reality.

  • McLaren and Ndebele both work for SECTION27. SECTION27 and the Institute for Economic Justice have produced a four-page Fact Sheet on the key funding trends in health in South Africa over the past five years, along with recommendations for steps that must be taken to improve public health care and narrow inequality in access to health care services.

#Vote4Health: Little accountability as (almost all) Health MECs dodge questions

Missed deadlines, non-communication and excuses sum up the overwhelming “responses” from the country’s nine health MECs when Spotlight asked them to reflect on their time in office and what people can expect from them beyond the elections.

As part of Spotlight’s #Vote4Health series, nine questions were posed to South Africa’s nine provincial MECs for health. Only two of the nine MECs provided answers. They were MEC Nomafrench Mbombo from the Western Cape and MEC Montseng Tsiu from the Free State.

The following seven MECs of health failed to provide answers to the nine questions despite a generous deadline of several weeks: Sasekani Manzini (Mpumalanga), Sibongiseni Dhlomo (KZN), Gwen Ramokgopa (Gauteng), Phophi Ramathuba (Limpopo), Fufe Makotong (Northern Cape), Helen Sauls-August (Eastern Cape) and Madoda Sambatha (North West).

Ramokgopa indicated that as she will not be available for re-appointment to the role of MEC after the elections she didn’t want to take part in the series. A revised set of questions was sent to her but these were not answered either.

All nine MECs were contacted through provincial communications and media departments. Popo Maja, national head of communications in the Department of Health, was copied on all emails. The provinces were given over two and a half weeks to respond when they were first contacted in mid-February. (KZN’s deadline was slightly shorter because correspondence was initially sent to an incorrect email address). Numerous follows up e-mails, phone messages, Whatsapp messages, SMSes were sent before deadline. Maja also responded to the emails asking his provincial colleagues to assist.

Not a single province met the deadline, two provinces requested extensions and did provide responses, some acknowledged receipt of the emails, forwarded these to colleagues they said would “handle the query”, which never happened and some communications teams simply ignored the media request.

The nine questions posed to the nine MECs were:

1)      Healthcare is close to the hearts of people – why would you say you are the right person to remain in the job as MEC?

2)      If you are reappointed as MEC for Health in your province, what will be your top priority in your province?

3)      Default rates on HIV/ TB remain a constant and widespread concern, what do you see as the main reasons why people are defaulting on treatments and how are you addressing these problems?

4)      What role do you see civil society playing in ensuring that healthcare is transformed and inclusive?

5)      Corruption and a dire shortage of skilled healthcare workers to fill positions are two of the biggest challenges in healthcare; how would you fix these problems?

6)      In your view, how does the role of the MEC for Health differ from the role of the Head of the province’s health department?

7)      How would you go about implementing policies set by the National Department of Health in your province and how do you see the relationship between province and national?

8)      What is the one thing you’re most proud of having achieved in your time as MEC?
9)      What is the one thing you wish you had done better on?

How the nine MECs responded:

Below we provide details of our interactions with all nine provinces, ending with the two provinces that provided answers to the nine questions. We have edited the original answers for length, but did not do heavy edits as it was preferable to let the reader access the unedited version.

GAUTENG MEC – Gwen Ramokgopa

Gwen Ramokgopa

Responsiveness: Ramokgopa’s team acknowledged receipt of the email and initially committed to giving input. Before deadline they said Ramokgopa had decided not to respond as she is not making herself available for re-appointment in the role. A new set of questions, focused on reflections on her role and what it has meant for the province, were sent to Ramokgopa’s team. There was no response or further communication in this regard.

KwaZulu-Natal MEC – Sibongiseni Dhlomo

Singongiseni Dhlomo

Responsiveness: The department spokesperson acknowledged the media query and copied it to a colleague who was also contacted directly by Spotlight.  No response to the nine questions was received despite follow-ups.

LIMPOPO MEC – Phophi Ramathuba

Phophi Ramathuba Photo by Gallo Images / Sowetan / Sandile Ndlovu

Responsiveness: Her department failed to acknowledge receipt of emails, though they received and read SMS messages that were sent as follow-ups. Ramathuba was tweeted directly and sent screen-grabs of the communication between Spotlight and her communications team. She said she would follow-up. No responses were subsequently received.

MPUMALANGA MEC – Sasekani Manzini

Responsiveness: Manzini’s communications department acknowledged receipt of the questions. They wrote to the Spotlight editors to check the credentials of the reporter and even when this was confirmed, Manzini’s communications team in Whatsapp messages, insisted the reporter was unknown to the  Spotlight editors (an obvious error or misrepresentation). Another set of emails were sent re-confirming the questions were indeed from Spotlight. No response was received.

Northern Cape MEC – Fufe Makatong

Fufe Makatong

Responsiveness: No response was received.

Eastern Cape MEC – Helen Sauls-August

Helen Sauls-August Africa Photo by Gallo Images / The Herald / Judy de Vega

Responsiveness: No response was received.

North West MEC – Madoda Sambatha

Madoda Sambatha

Responsiveness: No response was received.

WESTERN CAPE MEC – Nomafrench Mbombo

Nomafrench Mbombo

Responsiveness: Mbombo’s media liaison team asked for an extension and responded six days after the initial deadline.

  1. SPOTLIGHT:Healthcare is close to the hearts of people – why would you say you are the right person to remain in the job as MEC?

Mbombo: I am a community activist by heart and fighting for the right to access quality health services is my number one priority. Health is a human rights obligation, and we ought to take it upon ourselves in leadership to ensure services are delivered where it is most needed. I spent almost two decades teaching healthcare and I was involved in provincial and local government health departments in the Eastern Cape and KZN respectively. I also served in advisory and consultative capacity roles to various ministries of health in Africa and in multinational organisations across the globe.

After having served as the first ever female MEC appointed to the Western Cape Health Department, I gained enough insight into the executive role, and am well prepared to serve as MEC.

  1. If you are re-appointed as MEC for Health in your province, what will be your top priority in your province?

Mbombo: The provision of quality, person-centred healthcare to all in the Western Cape remains our number one priority. Our focus remains on providing our citizens with dignity and improved quality lives. We are working towards service transformation that will improve health, improve quality and patient experience. We are also working towards improved governance and accountability; improve infrastructure, and strengthening leadership and a positive culture, with improved staff satisfaction.

  1. Default rates on HIV/ TB remain a constant and widespread concern, what do you see as the main reasons why people are defaulting on treatments and how are you addressing these problems?

Mbombo: The main reasons for people defaulting on treatment in my view are:

  • Heavy pill burden, treatment fatigue,
  • Limited conversation with clients about their treatment journey and to co-plan,
  • Treatment as a biomedical intervention rather than supporting clients’ context and conditions,
  • Clients social economic conditions which include many social determinants e.g. unemployment, poverty, overcrowding, hunger, shelter, etc.
  • Migration – internal and cross border – main driver – looking for employment
  • Stigma in our communities
  • Disclosure to family and friends

The Western Cape Department of Health, with partners are putting measures in place to find the TB and HIV missing cases – to link them back to care. Both our HIV and TB case treatment have improved over the years because of research. We are, through NPOs, trying to build relationships with clients to build trust. We are supporting and investing in research to reduce pill burden

  1. What role do you see civil society playing in ensuring that healthcare is transformed and inclusive?

Mbombo: Civil society interaction is vital to ensure our service users are part of the health system. When I took office as MEC, central to my vision was to improve the patients’ voice. The aim was to ensure that we strengthen the voice of the patient, and that they become active participants in health, and allow them to participate within a system that is designed to serve them as patients. The idea is for them to move away from the notion of being mere recipients of health services, to encourage them to become active participants.

Increasing community representation at all levels, and ensuring community concerns are reflected on each of these structures, is thus of critical importance.

Each level of consultation provides opportunities for incorporating communities and their leaders into the healthcare system – instilling a sense of ownership and responsibility for health services in communities.

  1. Corruption and a dire shortage of skilled healthcare workers to fill positions are two of the biggest challenges in healthcare; how would you fix these problems?

Mbombo: With the shortage of health care professionals, in particular nurses, the Western Department of Health has developed a provincial nursing strategy to address this problem. Through this strategy the following has been put in place:

  • Rural nursing campuses were established to increase the number of nurses enrolled for nursing training
  • the department provide nursing bursaries to qualifying students
  • with regard to specialist nurse training ( post basic) the department has implemented a policy on study by assignment
  • we have also recently created relief posts  for nurses undergoing specialty training to enable hospitals to release more nurses for post basic / specialty training without compromising service delivery – this has significantly increased our training outputs in respect to these categories of nurses

We currently do not have shortages in the Western Cape of general nurses, we actually have surplus of this category, the challenge might be shortage of funded vacant posts. The shortage is on specialist nurses hence the focused interventions listed above to address this.

  1. In your view, how does the role of the MEC for Health differ from the role of the Head of the province’s health department?

Mbombo: The role of the MEC is in an executive capacity to implement provincial legislation, implementing appropriate national legislation, coordinate the functions of the Provincial Government and its departments, and preparing and initiating provincial legislation. The HoD on the other hand is to ensure that the vision of the Department of Health is implemented, and that health services are delivered to the people who most need it, as well as to ensure delivery of a comprehensive package of health services to the people of the province.

  1. How would you go about implementing policies set by the National Department of Health in your province and how do you see the relationship between province and national?

Mbombo: We are actively working with the National Department to ensure we work in alignment to implement policies, programmes and projects that directly impact the delivery of quality person-centred healthcare to all citizens in this province.

  1. What is the one thing you’re most proud of having achieved in your time as MEC?

Mbombo: Despite the challenges we face in the health sector, the Western Cape Department of Health has made impressive strides towards providing access to quality healthcare for all the people of the Western Cape and beyond. We can celebrate the highest life expectancy in the country, lowest inpatient crude deaths, the lowest child and maternal mortality rates nationally, the most successful HIV treatment programme in the country and 13 consecutive years of unqualified audits.  We can boast state of the art health facilities delivered in the past financial year, and take heart that we have successfully navigated the drought crisis of 2018.

Another key achievement is access to health services in the Western Cape. 91.5% of the citizens in the Western Cape have access to health services within 30 minutes of their residences. We also ensure rural access to healthcare through the HealthNet patient transport system that operates at around 230 pick-up points across the province. Every year over 150 000 patients are transported to healthcare facilities. This system is unique to the Western Cape.

  1. What is the one thing you wish you had done better on?

Not answered.

FREE STATE MEC – Montseng Tsiu

Montseng Tsiu

Responsiveness: (Tsiu’s media liaison team asked for an extension and responded one week after the initial deadline.

  1. Healthcare is close to the hearts of people – why would you say you are the right person to remain in the job as MEC?

Tsiu: I am a Health Professional who has served the Department for more than 30 years in various capacities from the grassroots in the most rural periphery to Provincial Director of Nursing.  This cumulative experience over the years has exposed me to various challenges and competing needs in the health fraternity with a purpose of saving lives of our people.

I therefore believe based on my background and passion to saving and changing lives of our people for the better, through the ANC policies that has sharpened my consciousness and commitment to health.  This is not a job but as a calling. I am conversant with the needs of the various stakeholders such as the different professional disciplines of health, the allied health workers, the support staff as well as the expressed needs of our communities who are eager to see transformation towards a responsive, efficient and effective health care system.

  1. If you are reappointed as MEC for Health in your province, what will be your top priority in your province?

Tsiu: The top most priority is to transform the workings of the department in the province through partnerships of the various stakeholders towards an increased efficient and effective health care provision leading to the implementation of the NHI.  We are grappling at the moment with the implementation of the 90-90-90 strategy which espouses the vision of health care trends in the world by the World Health Organisation, to be realised by 2020.

Efforts towards achieving this have begun as we are continuously evaluating our achievements every year.  Now we are at the stage of Tracing and Finding the Loss to Follow Up Patients who have to be on treatment immediately.  However, there is still a challenge of the cross border cases that require higher levels of cooperation between governments of neighbouring countries such as Lesotho, Namibia, Botswana, Zimbabwe and Mozambique, amongst others, of which the Free State is more closer to Lesotho.  Already, there are processes initiated towards finding a solution to this challenge with Lesotho.

If I am reappointed to the position of MEC for Health, this would be amongst my main priorities.

Filling of vacant posts ranging from non-clinical to clinical and Strategic Top Management posts.  I have realized that health is not only a subject of Clinical Services but require a fair balance between the core business and support services such as Clerical Services, Cleaning Services, Security, Laundry, Kitchen Services and others to achieve health objectives and realize the vision of the Department.

  1. Default rates on HIV/ TB remain a constant and widespread concern, what do you see as the main reasons why people are defaulting on treatments and how are you addressing these problems?

Tsiu: We need to upscale awareness and educational campaigns on the burden of diseases and for our patients to understand the importance of adherence to Screening, Testing and Treatment.  We have observed over a period of time that some of our patients are initiated on treatment but soon get lost to follow up because:

  • they abandon treatment as soon as they recover from adverse effects of illness and feel better. They associate taking treatment as a stigmatised phenomenon, especially long duration treatment such as that of TB and HIV.
  • Migration patterns within the country and neighbouring countries. In South Africa, patients are treated for free while in other countries they are subjected to a stipulated fee determined by each country.  Some of these patients are from poor backgrounds and cannot afford medical costs associated with their treatment.  These patients end up defaulting on treatment and automatically increase the default rates, hence the constant and widespread concern default rate becomes a factor.

In an attempt to address these challenges on HIV and TB, the Department has initiated a campaign of “Taking Primary Health Care to the People” since July 2018.  Through this campaign, both TB and HIV Units in the Department are pursuing the Screening, Testing, Counselling and Treatment Programmes in various communities in the province.  This is a constant because we do this in all the Districts targeting both rural and urban communities alike.

We have initiated a programme of Tracing those patients that are missing and lost to follow up for both TB and HIV.  We re-initiate these patients as soon as we find them.  Our Community Health Workers and Community Care Givers are playing a significant role in assisting the Department to achieve this objective as well as adhering to the goal of World Health Organisation with respect to the 90-90-90 Strategy.

We are further contributing towards achieving the objectives of the National Development Plan on reducing the rate of infection by 2030.

  1. What role do you see civil society playing in ensuring that healthcare is transformed and inclusive?

Tsiu: Civil Society is a strategic partner in health care.  We are working towards making our partnerships valuable and significant throughout all our programmes.  We are sharing common platforms with organs of civil society and advocacy groups.  Our concern is the fragmentation and competition amongst these critical voices.  This leads to undue misunderstanding of each other’s roles and thus leading to lack of coherence in our engagement.  We are committed through campaigns and programmes to involve these organs of civil society as partners in health care through the Provincial Council on Aids and their involvement in the various Departmental campaigns.

  1. Corruption and a dire shortage of skilled healthcare workers to fill positions are two of the biggest challenges in healthcare; how would you fix these problems?

Tsiu: On Fraud and Corruption

We have strengthened our Anti-fraud and Corruption Unit through the appointment of skilled, qualified and specialized personnel.  We have strengthened the risk Management systems in the Department to minimize and eliminate and form of instances of fraud and corruption.  These platforms will increase the ability for personnel to blow the whistle and be empowered to expose acts of fraud and corruption whenever they happen.

On filling of vacant posts

We are continuously filling all vacant posts with relevant, qualified and skilled personnel as and when these posts become vacant or as and when the need for importance and relevance becomes evident.

We have in the past three years made the following appointments:

Category 2016/17 2017/18 2018/19
Medical Officers 335 385 295
Medical Specialists 29 41 35
Nursing Assistants 401 372 130
Professional Nurses 147 314 190
Staff Nurses 70 76 77
Pharmacists 62 41 34
Total 1 044 1 229 761

The department has been allocated 127 posts through HR enhancement grant on HR capacitation. It is an indirect grant of R 13,7 Million for the following categories:

Medical Officers 13

Medical Specialists 8

Professional Nurses 43

Enrolled Nurses 12

Staff Nurses 31

Community Services 20

All the above appointments have been finalized. An additional amount of R2,9 Million is being processed to employ support staff as follows:

Cleaners 100

General workers 50

Porters 25

Forensic Officers 12

The support staff will be distributed across the province for enhanced service delivery.

  1. In your view, how does the role of the MEC for Health differ from the role of the Head of the province’s health department?

Tsiu: The MEC is the Executive Authority of the Department, this is where the strategic and policy direction is given in terms of what the country wants to achieve through the vision as outlined by the governing party in line with the electoral mandate.

The Head of Department is the Accounting Officer who must ensure that the vision of health is implemented in uniformity.  The accounting officer must ensure that there is a fair, adequate and equitable distribution of resources and responsibilities to implement the vision of both the National and the Provincial Department of Health.

  1. How would you go about implementing policies set by the National Department of Health in your province and how do you see the relationship between province and national?

Tsiu: South Africa is a unitary state, with national as the centre and the provinces as the strategic links.  The National Department of Health sets the tone with regards to how health should be administered and managed through the set National Core Standards and Objectives, while the Provincial Departments aligns their own systems to the national strategic objectives in a commonly defined and response to the burden of diseases.  For example, we are implementing the National Core Standards of Health determined by the National and the Provincial Departments, the National Strategic Plan on HIV and AIDS, 90-90-90 Strategy and the National Development Plan.

In no way, the province may operate or execute any mandates that are contrary to the framework of the National Department of Health.

The Provincial Department reports on its achievements annually to the National department and when required to the Parliament of the Republic on its activities.

  1. What is the one thing you’re most proud of having achieved in your time as MEC?

Tsiu: The launch of “Taking Primary Health Care to the People”.  This is the milestone campaign that brought about the realisation of the long theorized vision of a preventative health care system.  The Health care system of South Africa has been mainly curative and hospital centred in approach yet neglecting the preventative element that is community centred and people driven.   Over many years, this approached is theorized and not driven to implementation.  I am happy to see an old man receiving their eye sight through a cataract campaign, others getting spectacles, hearing aids, orthostatics; wheelchairs, walking aids and many others provided by the Department.

  1. What is the one thing you wish you had done better on?

Tsiu: If I may, let me sponsor only two.  Firstly, I wish that I was able to increase the numbers of women in Strategic positions including Top Management of the Department.  Secondly, I wish I had more time and resources to implement improvements in Infrastructure with state of the art equipment that conforms to the dictates of the 4th Industrial Revolution and Artificial Intelligence and thereby expanding access to health care for people in the rural areas with dedicated professionals to serve them there.

 

#Vote4Health: Five appointments to watch after May 8

Apart from a potential change in Health Minister, several key other health leadership roles may or may not change after South Africa’s May 8th elections. We’ve identified five that we will be keeping a particularly close eye on.

We will have new health MECs in Gauteng and KZN

While the National Minister of Health has significant powers, the day-to-day running of the public healthcare system in South Africa is mainly done at provincial level. Provincial Ministers of Health, or MECs (Member of Executive Council) together with their heads of department have a critically important role to play in addressing the widespread dysfunction in our provincial healthcare systems.

The current Gauteng MEC for Health Dr Gwen Ramokgopa and the current KwaZulu-Natal MEC for Health Dr Sibongiseni Dhlomo have both indicated that they will not be returning to their current roles after the May 8th elections. Together, these two provinces account for almost half (over 40%) of South Africa’s population. KwaZulu-Natal has made headlines for that province’s oncology crisis and Gauteng for the Life Esidemeni tragedy (under former MEC Qedani Mahlangu), but both provinces have much deeper systemic problems that will require strong leadership for years to come.

As with the appointment of the National Minister of Health, it will be telling to see whether these two MEC appointments are made based mainly on political considerations or based on ability and commitment to do the job well. MECs are appointed by Provincial Premiers, although the party or parties in power in the province obviously have some influence on the Premier’s decisions. Either way, these appointments will have a major impact on public healthcare services in the country’s two most populous provinces and are arguably as important as the appointment of the National Minister of Health.

We may get a new Director General

The Director General for Health is the head of the National Department of Health and is the accounting officer responsible for managing the Department’s affairs. From 2010 the Director General of health in South Africa has been Malebona Precious Matsoso. Matsoso is widely respected and has a strong international profile, having for example played a key role in the United Nations Secretary General’s High-Level Panel on Access to Medicines.

We understand that Matsoso is one of two candidates in the running to be the next head of UNITAID (a multi-lateral global health initiative). This position would be a natural fit for her given her UN and previous WHO experience. Reports that she was side-lined from recent government processes relating to National Health Insurance (NHI), also suggests that she may be moving on.

Director Generals are appointed not by Ministers, but by the President. In all likelihood, it will be up to President Cyril Ramaphosa to make this appointment after the elections. If Matsoso is indeed replaced, it will be critically important that the new appointee is an excellent manager who can form meaningful alliances with civil society and build the state’s capacity to deliver quality healthcare services.

There may be a new Presidential Health Advisor

The role of the Presidential Health Advisor is supposed to be mostly, as the name suggests, advisory. Yet, the current Presidential Advisor Dr Olive Shisana appears to have been granted significantly greater powers than one might expect – particularly regarding the NHI Bill.

The fact that the NHI Bill process hit some serious snags under her stewardship does not bode well for her future in this role. A leaked letter from National Treasury questioning changes to the bill revealed serious fissures in government regarding important details of NHI, as did subsequent media reports suggesting that the Director General of Health had been side-lined from the Bill process.

Will the Free State Department of Health get a new head?

Heads of provincial health departments are the accounting officers for their departments and their roles are roughly analogous to that of the Director General’s role at a national level.

Spotlight has reported extensively on controversial tenders and contracts in the Free State and North West provinces. While the National government has intervened in the North West and some heads have rolled there, the same cannot be said in the Free State Department of Health, despite a litany of crises and questionable contracts. These include the following:

  • The poor services provided by the private ambulance company Buthelezi EMS and the company’s alleged overcharging of government (See the Health4Sale series).
  • Allegedly sub-standard theatre equipment that the department purchased from a company (Mediquip Hub SA) with politically connected directors.
  • The province’s contract with the Gupta-linked company Mediosa (AKA Cureva).
  • An unlawful stem cell trial that was started at Pelonomi hospital in 2016 and a contract with a private company to provide unproven stem cell treatments for knee problems at the hospital.
  • The dismissal of over 3 000 community healthcare workers in 2014 and the state’s decision to prosecute some of these workers for peacefully protesting their dismissal (at the same time that Buthelezi EMS and Mediosa/Cureva were awarded contracts in the province). After a Magistrate’s Court convicted the workers the convictions were overturned in the Bloemfontein High Court in November 2016.
  • Various healthcare service delivery challenges, such as the ongoing orthopaedics crisis in the province.

While the Free State has had three different MECs for Health over the last five years, the Head of Department for the entire period has been Dr David Motau. In the many investigations we have done in the Free State, it is his signature that keeps coming up time and time again. Maybe most notably, it is he who signed off increases for Buthelezi EMS when the Free State Department of Health was puzzlingly taken out of administration by then Premier Ace Magashule for five days in February 2017.

Heads of provincial departments are appointed by Provincial Premiers. Motau has been in his current position since the days when Ace Magashule was Premier of the Free State. Whether Motau remains Head of Department after the elections will give some indication as to whether or not Ramaphosa’s new dawn and its promise of better governance  has reached this province.

 

#Vote4Health: Is the National Quality Improvement Plan for health good enough?

By Ektaa Deochand

2018 was a significant year for the development of health policy. Among others, it saw the ministry of health acknowledging the parlous state of the health system and the need to address systems failures while attempting to achieve universal health coverage through National Health Insurance (NHI).
On 24 August 2018 at a Department of Health stakeholder consultation on NHI, the Draft Quality Improvement Plan (“the NQIP”) was released. On 19 and 20 October 2018, the Presidential Health Summit took place which culminated in a report meant to facilitate the creation of a collective ‘health compact’. These two documents are meant to mark the beginning of a roadmap toward achieving a quality health care system.

The NQIP represents a recognition by the Department of Health that there are deficiencies in the current health system which require the development of a detailed and adequately funded quality improvement plan and guideline. Although this is a welcome recognition, does the NQIP provide a realistically realizable plan in order to do this?
The NQIP appears to be a plan for yet another plan in order to bring all the existing initiatives together, identify those that are working well and review the implementation of those with poor results.
Before the introduction of an improvement plan, there should be a detailed evaluation of existing data and an examination of the state of health care facilities in the country, which appears to be lacking. The Access to Quality Health Care in South Africa Report identified the lack of publicly available comprehensive, accurate data on both the public and private health sectors, as a key constraint to detailed evaluation of efficiency, equity and quality in the South African health system.
The principles of the NQIP are commendable, and at first glance appears to be a standards-and systems-based quality improvement process, focusing on health outcomes by building management and team work capacity and health facility readiness. However, the steps in the plan seem out of sync with these principles.

Human Resources

There are some immediate sensible interventions identified in the NQIP, such as lifting the moratorium on the filling of critical and essential posts. In the 2019 budget review, R2,8-billion from the National Health Insurance Indirect Grant has been reprioritised to the new human resources capacitation grant over the next three years to fill critical posts. R1-billion has also been added to the community outreach services component of the HIV grant for the employment of community health workers, however this will only be allocated in 2021/22.

The Presidential Health Summit Report (“HSR”) similarly recommended that the moratorium be lifted on critical posts and that the policy on remuneration of work outside the public service be reviewed in order to limit impact on service delivery. Some identified medium term actions of the HSR were to validate and optimise the use of the PERSAL and HR management information systems and to review the roles and responsibilities of each sphere of government.

It remains to be seen how these recommendations will be carried through, as there is currently no national applicable human resources strategy document despite the National Health Act requirement that the Minister and National Health Council determine guidelines for provincial departments and district health councils to implement programmes for the appropriate distribution of health care providers and health workers.

Infrastructure

The state of many health care facilities results in ever decreasing faith in the health care system. Millions of Rands over many years have been dedicated to infrastructural improvements and maintenance. Despite this, insufficient progress has been made.

The HSR notes that the Department of Health “has a health infrastructure plan but to date the country has had neither the expertise nor adequate funding to implement the plan. In some cases, health infrastructure construction that has been successfully completed has either cost more than the initial budgeted amount or facilities have been constructed that fail to meet the need for the service required.” It also states that in most cases there is insufficient capacity for project implementation, monitoring and evaluation.

The Ideal Clinic Realisation and Maintenance Programme (ICRM) was developed to address deficiencies in the quality of Primary Healthcare Services (PHC). Despite the NQIP asserting that the first two phases are complete and the focus is now on implementation, it is unclear what the progress has been of the ICRM to date nor whether it should be pursued as an effective method of improving quality care. Many clinics which have been identified as ‘ideal’ such as the Philani Clinic in Queenstown remain far from ideal. The infrastructure remains poor, human resources are insufficient, and very little support is provided to the clinic committee. Operation Phakisa was launched in 2014 to scale up the ICRM, but in 2018 clinics only achieved 47% compliance with the assessments conducted by the Office of Health Standards Compliance (OHSC) and only 43% of clinics met the Ideal Clinic Status.

Some recommendations of the Operation Phakisa Ideal Clinic Laboratory were to develop a standard blueprint for the construction of new facilities or existing facilities needing refurbishment; and to develop maintenance hubs in districts to ensure that planned maintenance is carried out. The 2017 Health Review indicated that the NDOH and the provinces were in the process of completing schedules for PHC facilities which need refurbishment. It is unclear what the status of these schedules are nor whether the recommendations of Operation Phakisa were ever implemented.
The HSR recommendation on infrastructure is that there must be an investigation and revision of the ‘national master infrastructure plan’ and that alternative funding mechanisms for infrastructure development be explored. The HSR refers to an assessment conducted in 2015, which states that 20% of the PHC infrastructure requires replacement, and that the data concerning PHC facilities is too inconsistent and poor for detailed planning. Greater transparency is required regarding these assessments, as well as information as to whether any independent assessments have been done.

Over the next three years R19,2-billion has been allocated to the health facility revitalisation grant and a further R4,3-billion has been allocated to the health facility revitalization component of the NHI indirect grant. This is meant to fund 1 500 infrastructure projects, including new facilities, upgrades, refurbishments and maintenance. Additional allocations have been added to fund the new academic hospital in Polokwane. However, in order for provinces to access this grant a two-year planning process is needed in which provinces are assessed and required to obtain a minimum score of 60% in order to qualify for the incentive. Only three provinces qualified in the 2019/20 financial year (KwaZulu-Natal, Eastern Cape and Western Cape).

Certification by the OHSC

The arduous certification/accreditation process in terms of the NQIP brings more questions than answers to light. It states that “it is a requirement that all health facilities designated for NHI meet the quality standards set by the Office of Health Standards Compliance. Thereafter, 25% of facilities will need to achieve accreditation as set out in the draft NHI Bill within a year.”

Certification by the OHSC requires an OHSC that is adequately capacitated in order to effectively measure and enforce compliance with the Norms and Standards Regulations Applicable to Different Categories of Health Establishments (which came into effect on 2 February 2019). The 2016/2017 Annual Inspection Report of the OHSC shows that in that financial year, only 17% of health establishments were inspected. The OHSC budget allocation has only increased by 5.5% this financial year, and its total staff complement is expected to remain at 121. Based on its existing capacity and budgetary constraints, unless there are serious adjustments in budgetary allocations, the OHSC will not be able to inspect all the public health establishments to assess compliance.

Accreditation for the purposes of contracting with the NHI Fund

There are additional criteria listed in the NHI Bill for facility accreditation by the NHI Fund, such as provision of the minimum required range of services; allocation of the appropriate number and mix of healthcare professionals; adherence to treatment protocols and referral networks and submission of information to the National Health Information Repository and Data System.

To make matters even more complicated, the NQIP identifies four levels of achievement within the NHI accreditation process, where only facilities with full compliance will be permitted to provide the complete range of services offered in the NHI.

Whilst private and possibly some public facilities may meet the full compliance criteria, it is unclear how communities currently served only by public facilities would have access to health care services if these facilities failed to meet the accreditation criteria. This risks a reduction in access to services and a regression in realisation of the right to access health care services. Potentially it could mean that people with access to poor quality services now end up with access to no services at all as facilities may not be accredited and therefore not funded. The process for bringing non-compliant facilities to a state of compliance is not provided for in the NQIP.

Governance, Management and Leadership

With regard to governance and management, the NQIP states that there needs to be a wholesale transformation of the management system with decentralization to hospital managers, however it fails to provide details as to how the capacitation of this level of leadership will be carried out.

The HSR identified that there has been poor implementation of governance policies and that there is a need to address political interference in management processes. It states that politicians must have oversight but not get involved in the administrative execution of policies, but does not provide further details as to how this will be monitored. It does however recommend the creation of an anti-corruption forum for the health care sector, which has commendably, recently been established by the Special Investigating Unit.

The HSR further proposes that clinic committees and hospital boards be capacitated according to standardized guidelines. Currently only four provinces have passed legislation or policies relating to the regulation of these committees, and even where committees do exist, they are seldom supported by district health management to effectively fulfil their role.

Financial Management

The NQIP is mainly silent on financial management or resource allocations. The HSR however, discusses a ministerial task team investigation into the financial conditions at public hospitals. It found similar issues in all provinces as a result of over expenditure and accruals. It recommended that provincial treasuries be engaged on the baseline allocations with priority given to rural communities. The HSR proposed interventions include; reduction of accruals and understanding the cost drivers; limiting the role of conditional grants as a core resource allocation mechanism and assessing inefficiency created by restricted conditionalities; revisiting the equitable share formula; reconsideration of the human resource mix; addressing bloated management structures focusing on staffing service delivery; creating incentives for better revenue collection; and revising the tariff structure.

Conclusion

The NQIP is the answer meant to alleviate the concerns raised around NHI. Whilst it demonstrates strong principles and optimistic ideals, the practicality of the plan remains muddled in the mix of health compact processes. The NQIP alone is insufficient in its current form to address the major system flaws of the public health sector. The HSR sheds some frightening light on the broader issues, and as such, a much more detailed consolidated pathway and reprioritisation of budgets will be required in order to address the compounding issues relating to human resources, infrastructure, and governance if these plans are ever to translate into concrete change.

Deochand is an attorney at SECTION27.

#Vote4Health: Seven years of struggle at Holy Cross Hospital

By Kathryn Cleary and Zizo Zikali

The main entrance to Holy Cross Hospital, 23km from the centre of Flagstaff, Eastern Cape.

The long-suffering Holy Cross Hospital outside Flagstaff, Eastern Cape, has a troubling history. The hospital services eleven traditional houses, (roughly 100 villages) in the Ingquza Hill Local Municipality, part of the OR Tambo District. As part of the #Vote4Health series, Spotlight and Health-e News re-visited the hospital after years of turmoil. The visit follows NSP Review’s harrowing 2013 ‘Death and Dying’ report – as well as drastic water shortages, near collapse of the hospital and numerous government interventions.

While Holy Cross hospital has a longer history, our timeline starts in January 2012 as a R105 million refurbishment of the hospital is completed. The refurbishment forms part of the broader Department of Health Hospital Revitalisation Programme.

January 2012, refurbishment of Holy Cross Hospital finishes.

13 September 2013, NSP Review, a Section27 and Treatment Action Campaign (TAC) publication (now known as Spotlight), publishes a comprehensive report titled “Death and Dying in the Eastern Cape.” The report details heartbreaking accounts of poor service delivery in the Eastern Cape’s public health sector. One story, Baby Ikho: He should have lived, tells the story of a toddler’s final hours in Holy Cross Hospital after being admitted with a chest infection. With oxygen needed to save his life, the story recalls the attending doctor, Dr Dingeman Rijken, tearfully watching, helpless, as  the last few ounces of oxygen in the hospital ran out, leaving Ikho gasping for air, and eventually passing away. Baby Ikho’s story was read by many, including some at the Department of Health, the Health Professions Council of South Africa (HPCSA) and the Office of Health Standards and Compliance (OHSC). The story was later redacted in the published version of the report to permit further investigation by the National Department of Health.

19 September 2013, Minister of Health Aaron Motsoaledi responds publicly to the report. In a media briefing Motsoaledi confirms that the Department was aware of the challenges faced by the Eastern Cape; particularly the deplorable state of public healthcare services in the OR Tambo District. The report prompted an urgent investigation by the National Department of Health. The investigative team’s findings included gross shortages of vital medical equipment in the maternal ward, including an absence of fetal heart monitors and thermometers; poor staff attitudes towards patients and other staff, as well as poor management and financial corruption.

Motsoaledi recommended that the CEO and Nursing Services Manager be suspended and put under investigation immediately, and for the Hospital Administrator to be investigated. Further, he urged that the CEO and Nursing Services Manager be reported to the South African Nursing Council (SANC).

Additional recommendations included a forensic audit of the hospital and an intervention at the District level. Vital medical equipment was also to be purchased and distributed to Holy Cross as well as 13 District, 2 Regional and 3 Specialised hospitals in OR Tambo. This was scheduled to occur the week after the media briefing, 23 September 2013.

2014, the OHSC issues an inspection report scoring Holy Cross Hospital at 43 percent, a failing score.

21 October 2015, Spotlight publishes a follow-up story titled “Holy Cross: Some progress, but all is not well”. The article highlights the devastating water shortages at the hospital, lasting at times for over a week. A Doctor quoted in the story recalled a water outage for six weeks; having dire consequences for patients and staff.

Other issues included staff accommodation, staff shortages, a lack of permanent staff and a faulty top-down management system. A source in the story claimed that the centralisation of the provincial management system was inefficient, and that sending paperwork off to Mthatha for signatures was impractical.

2016 the OHSC scores Holy Cross Hospital at 60 percent. While still below the OHSC pass level of 80 percent it is nevertheless a marked improvement from 2014.

2016-2017, the OHSC issues another inspection report rating the Eastern Cape at 43 percent, and Eastern Cape hospitals at 50 percent. Nationally, the Eastern Cape had the lowest score.

January 2017, Holy Cross residents take their frustrations to the streets demanding improved health services at the hospital. Residents barricade the road linking the hospital to the R61 with burning tyres; everything was brought to a stand-still, including ambulances and patient transport vehicles.

The leader of the strike, Dumisani Mbangatha states that grievances included long queues, poor staff attitudes, a shortage of medicine (as a result patients were sent home without their medication), and nepotism.

Mbangatha and residents also demand that (now former) CEO Gloria Mazeka should be removed from her position.

Mbangatha added that according to the hospital’s organogram, the Board of Directors was to report to the community, however there were no open lines of communication between the Board and the community.

In response to community uproar (now former) MEC Dr Pumza Dyantyi visited the hospital. Dyantyi received a memorandum from the community and asked a task team to further investigate allegations.

6 April 2017, MEC Dr Pumza Dyantyi returns to Holy Cross to receive the task team report.

10 April 2017, In an article titled ‘The hell suffered by patients at Holy Cross Hospital’, Health-e reports that the water crisis and other issues at Holy Cross are far from over.

August 2017, Holy Cross Hospital NEHAWU Chairperson Mthandwa Zitha says that the functionality of the hospital had been compromised due to a lack of non-permanent senior management officials. At the time, Holy Cross had only an Acting Hospital Administrator, and critical posts such as Chief Medical Officer and Nursing Services Manager were vacant. Zitha recommended that a situational analysis be conducted concerning the high rate of staff turnover at the hospital.

Adding to this, the hospital’s DENOSA Chairperson Mzolisi Ludumo, said the issue of vacant positions in management is not a challenge solely faced by Holy Cross, but that District hospitals such as Holy Cross, St Patrick’s and Grenville experienced similar challenges in human resources.

December 2017, Health-e reports that soon nurses at Holy Cross could be left without accommodation. Nurses residing in trust houses (used as nurses homes) were notified to vacate the properties before 2 January 2018, the eviction notice was from the Anglican Church Authorities who claimed that the land on which the nurses’ homes were situated was owned by the church. The then Anglican Bishop Thanduxolo Magadla claimed that they wanted to renovate the buildings to create decent accommodation for the nurses who in turn would pay rentals to the church.

According to former hospital board chairperson Mthuthuzeli Sinukela, the eviction process was unpleasant and nurses complained of harassment during the process.

February 2019, Health-e further reports that there was a dispute about the rightful owners of the land where the trust houses are located; the dispute was between NEHAWU, the Anglican Church, the traditional leaders and the community.

The community claimed that the hospital land belonged to the community, while the traditional leaders said the church is the rightful owner have a title deed to prove it. However, NEHAWU Chairperson Mthanndwa Zitha claimed that the houses were built by the Department of Health many years ago to accommodate hospital staff.

Ingquza Hill Traditional Council Thandisizwe Mgwili confirmed that the rightful owner of the hospital land is the church.

April 2019, a copy of the 2017 investigative task team report is requested from the Eastern Cape Department of Health. Failing to respond to queries from Spotlight, a PAIA request for the document was later submitted on 9 April.

In April 2019 Spotlight and Health-e also publishes a new article on the situation at Holy Cross and a timeline of events at the hospital over the last seven years (the document you are now reading).