Chintsa Secrets: October 2013

Report by Dr. Madeleine Muller:

As you all remember we marched to the MEC offices on the 13^th of September to hand over a memorandum to the MEC of Health. It was received by Dr Mbengashe, the SG and HOD of Health. In the memorandum we asked for a plan on fixing the Eastern Cape by 11 October.

The Coalition then met on the 14^th of October, by which time we had no reply and I include the press statement below on the 15^th expressing our disappointment.

We were therefore very pleased when a reply was finally sent on Friday, the 18^th of October. It does mention all the points in our memorandum but is unfortunately a fairly weak document with general promises with no timelines or specific plans of actions (e.g. they will fight corruption). We are currently interrogating this plan in detail and the coalition will respond to it.

What is amazing is that a first step of a conversation has opened up. The Health department is making commitments to improve care and we will continue to advocate for specific plans and timelines, which we will then monitor.

The most phenomenal experience for me out of these last 4 weeks are the many organisations that have joined the coalition and the amazing rise of civil society we have seen. Who know what might be possible!

Remember to spread the word about how to get in contact with the ECHCAC and stay informed about our work:

Facebook: www.facebook.com/EChealthcrisis (please like the page!)

Website www.echealthcrisis.org (please sign the memorandum!)

Phone: Kwazi Mbatha: 0780599309 or Anele Yawa: 073 555 8849

Email: echealthcrisis@rhap.org.za

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EASTERN CAPE HEALTH CRISIS ACTION COALITION

15 October 2013

ECHCAC press statement: Request for a meeting with Premier, Provincial Government and the ANC following non-response from MEC Sicelo Gqobana

EAST LONDON - The Eastern Cape Health Crisis Action Coalition (ECHCAC) resolved at a meeting yesterday to immediately write to the ANC, the Eastern Cape standing committee on health and the Premier regarding Health MEC Sicelo Gqobana’s continued failure to respond to the memorandum we presented to his office on 13 September 2013.

We will request a meeting with these parties by the end of this month and will thereafter consider our options.

The health crisis in the Eastern Cape requires not only urgent action, but also the development of a recovery plan to make systemic changes to fix the healthcare system in the Eastern Cape, large parts of which are in a state of crisis and collapse.

The publication of a special investigative report by the Treatment Action Campaign and SECTION27, “Death and Dying in the Eastern Cape” did prompt a response by the national health minister. His response did not include a recovery plan, but did attempt to deal with some of the immediate crises identified in the report.

Whilst applauding the response of the Minister, in which he accepted that the Eastern Cape healthcare system is in a state of crisis, our members report that there been little real change on the ground. Unfortunately we have received a number of reports that other than at Holy Cross Hospital the promised equipment has not yet arrived at most of the institutions where the situation is equally desperate. Promised blood pressure machines, wheelchairs and other equipment has not reached many of the facilities. In fact, there are reports of a deepening crisis. We have also received some reports that health workers are less keen to report challenges following threats of victimization and the attention generated by the report.

ECHCAC’s demands were set in a memorandum accepted on behalf of the MEC by Thobile Mbengashe, the Head of Department for Health in the Eastern Cape, at a march in Bhisho on September 13.

However, a deadline to respond by October 11 has been ignored by the MEC and his officials.

We note media reports in which the MEC’s spokesperson Sizwe Kupelo is quoted as stating that the provincial department of health feels that Minister Motsoaledi's previous press conference qualifies as a plan and fills the conditions of the memorandum. Kupelo reportedly told a journalist that the national minister has already responded by tabling his plans to address the concerns raised.

Yesterday’s meeting was attended by a wide range of ECHCAC’s ever-growing organisational membership including the Treatment Action Campaign, Democratic Nursing Organisation of SA, Rural Rehab SA, Rural Health Advocacy Project, Keiskamma Trust, Democracy From Below, Budget and Expenditure Monitoring Forum, SECTION27, Public Service Accountability Monitor, Community Health Workers Chalumna, Black Sash, South African Medical Association, the Federation of Unions of SA, Rural Doctors’ Association of SA and the Methodist Church of South Africa.

ECHCAC is inspired by the continuously increasing unity amongst a broad spectrum of civil society and call upon religious leaders, social movements, NGOs, healthcare professionals and members of civil society to join our campaign to work with the government to fix the healthcare system in the Eastern Cape. The purpose and principles of this campaign were agreed and are set out in a separate document.

We are particularly encouraged by the increased flow of information from healthcare professionals working in the Eastern Cape and the groundswell of support for ECHCAC at the community level. We encourage healthcare professionals and users of the system to speak out to assist us in our effort to ensure that the people of the Eastern Cape have access to quality healthcare as is promised by the Constitution.

ECHCAC will now urgently write to and request meetings prior to the end of October with:

* The Premier of the Eastern Cape Mrs Noxolo Kieviet;

* The Standing Committee on Health in the Eastern Cape;

* The Eastern Cape leadership of the African National Congress.

ECHCAC also condemns any intimidation or victimisation of healthcare professionals who speak out and call upon the MEC for the Health and the National Minister of Health to make clear public statements to this effect.

Unless the above meetings lead to agreement that there is a need for a comprehensive recovery plan, combined with actions to fix life threatening problems, ECHCAC will organise further demonstrations, mobilisation and protest within the Eastern Cape and throughout the country.

If we do not begin to see urgent action and a movement towards systemic change in the Eastern Cape public healthcare system it was resolved to explore the option of taking legal action. In the run up to the 2014 Elections, we call upon the Eastern Cape government to take seriously people’s demands for their constitutional right to have access to healthcare met.

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The ECHCAC is a coalition of organisations and individuals primarily from the Eastern Cape dedicated to fixing the healthcare system and ensuring the realisation of the constitutional right to health in the Province, and includes:

Visit the ECHCAC website and sign the memorandum at: http://echealthcrisis.org/

Contact:
Kwazi Mbatha: 078 059 9309 / ECHealthCrisis@rhap.org.za

Anele Yawa: 073 555 8849

This is the first in a series of updates from the Eastern Cape Health Crisis Action Coalition (ECHCAC), a Coalition of organisations and individuals dedicated to fixing the healthcare system and ensuring that the constitutional right to health is fulfilled in the Eastern Cape. Please contact us through the means provided below to get involved.

Email: echealthcrisis@rhap.org.za Web: www.echealthcrisis.org
Facebook: www.facebook.com/EChealthcrisis
Phone: Kwazi Mbatha: 078 059 9309 or Anele Yawa: 073 555 8849

CONTENTS:

INTRODUCTION
Part 1: OR TAMBO HEALTH DISTRICT
Part 2: HOLY CROSS HOSPITAL, FLAGSTAFF
Part 3: THE EASTERN CAPE IN GENERAL

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INTRODUCTION

On 19 September 2013, the Minister of Health, Dr Aaron Motsoaledi, held a press conference in response to pressure from the Eastern Cape Health Crisis Action Coalition (ECHCAC) and the release of a report on the Eastern Cape health system. He made several commitments to fix the health system in the Eastern Cape. This document summarises his commitments and is part of the ECHCAC’s effort to monitor implementation of them. We encourage people to contact us to report evidence of implementation or its absence. It is up to communities, patients using the health system, and civil society to ensure that government delivers on its commitments. Report evidence of:
• New equipment
• Improved access to medication and supplies
• Improvements to infrastructure
• New appointments
• Other evidence of implementation

This document also points out some of the gaps in the commitments made and highlights the need for further attention from the MEC for Health in the Eastern Cape, Sicelo Gqobana, and the Minister.

Report problems not addressed through the Minister’s commitments including:
• Human resources problems, in particular in relation to recruitment and retention of health care providers in rural and remote areas
• Problems outside of the OR Tambo District
• Facilities in particular need
• Medicine and medical supplies availability

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1. OR TAMBO HEALTH DISTRICT

The Minister acknowledged that there are deep problems in the OR Tambo District; in particular he noted: the state of buildings, electricity supply, water supply and overall space availability is lacking in health facilities. This is what he reported:

1. Eight clinics need to be demolished and rebuilt from scratch. Five will be built in this financial year with contractors on site by January 2014 and the contract period will be eight months. We are liaising with the Department to identify which clinics these are.

2. Bambisana and Zithulele hospitals need to be entirely rebuilt. Contractors will be on site in May 2014 and June 2014 respectively and the duration of the work will be 36 months (3 years). The appointmentof service providers will be finalized by December 2013 (Bambisana) and January 2014 (Zithulele).

3. St Barnabas Hospital’s psychiatric wing will undergo major refurbishment.

4. 30 clinics do not have enough space in terms of the number of patients they are treating. We are liaising with the Department to identify which clinics these are.

5. There are varying problems of water and electricity in clinics.

6. There is an urgent need for additional space for doctors’ consulting rooms, patient waiting rooms and toilets. To address this, the national Department of Health will erect park homes with a 20 year lifespan that have been designed for the environment – they are cheaper than building, are cooler thereby reducing the need for air conditioning. Four have been erected with the balance completed by early next year. We are liaising with the Department to identify how many of these there will be and where. They should:
a. Be connected to water – municipal or a borehole.
b. Have electricity, whether by connection to an electricity grid or by a generator.
c. Be connected to the sewerage system or a septic tank. Please report if you know of these units and if they have all of these features.

7. Two nursing colleges, Butterworth and Madzine-‐Ka-‐Zulu will be refurbished with the contractor on site by October 2013 and completion by March 2014. Please report if the contractors are seen on site.

8. All hospitals in the District will receive the equipment listed as being provided to Holy Cross Hospital below.

9. The costing of the OR Tambo infrastructure work is a priority and will be completed by the end of this year.

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2. HOLY CROSS HOSPITAL, FLAGSTAFF

A ministerial task team visited Holy Cross Hospital and interviewed five nurses and midwives and inspected the maternity wards. This is what they found:
-‐ Most nurses have been working at the hospital for over 10 years
-‐ In maternity there were eight advanced midwives (one working as an area manager), nine midwives, five enrolled nurses and three enrolled nursing assistants.
-‐ There was no basic equipment for use for patient care
-‐ There was no blood pressure machine supplied by the Province (nurses contributed from their own pockets and brought a BP machine)
-‐ No fetal heart monitors (three midwives had their own feto scopes)
-‐ Few thermometers
-‐ No glucometer
-‐ No baby warmers on the resuscitators with babies being resuscitated in cold rooms
-‐ A lot of linen, green towels, gowns and sheets were used to cover chairs in the ward
-‐ Most nurses interviewed said they tried their best, but there was no team work
-‐ All admitted that there were some practices by some colleagues that may contribute to sub-‐optimal care
-‐ They are aware of some instances where charting of vital evidence, medicines and the patrogram are recorded even though not executed
-‐ Most deliveries (births) have records done after delivery
-‐ All nurses interviewed agreed that staff attitude towards patients, relatives and among themselves is not acceptable
-‐ Nurses feel there is generally no leadership and no guidance
-‐ everyone does as they like
-‐ There are nurses who are dedicated, but are discouraged by the actions of others
-‐ The facility lacks quality leadership and management
-‐ Holy Cross was part of the Hospital Revitalisation Programme and R105-‐million was spent on refurbishing it and completed by January 2012
-‐ There is no record of meetings, in-‐service education, meetings to discuss mortality rate
-‐ Nurses and midwives were not made aware of crucial policies, guidelines and targets.
-‐ Folders that could be purchased for R3 000 were purchased for R30 000.

This is what the Minister has committed to:
-‐ The Hospital CEO will be suspended with immediate effect pending a full investigation into her role in respect of serious dereliction of duty, mismanagement and harm to patient care;
-‐ The Nursing Services Manager will be suspended with immediate effect pending a full investigation into her role in respect of serious dereliction of duty, mismanagement and harm to patient care;
-‐ Progressive disciplinary measures will be instituted against the Hospital Administrator;
-‐ The CEO and Nursing Services Manager will be reported to the SA Nursing Council for breach of professional ethics;
-‐ An urgent forensic audit will be done into the purchase of the hospital files;
-‐ A massive amount of equipment has been purchased by the national health department including:
o 20 Baumanometers
o 10 Neonatal Ambubags
o 10 Paediatric Ambubags
o 10 Adult Ambubags
o 10 Pulse Oxymeters
o 2 Electric POP Saw
o 8 Infusion Pumps
o 5 patient body warmers
o 2 Vacuum extractors
o 5 000 disposable thermometers
o 10 suction machines
o 5 glucometers
o 10 Foetoscopes
o 5 ENT sets
o Laryngoscopes
o Gloves
o syringes and needles.

This equipment should have been delivered to the hospital by now. The same equipment is to be provided to the other 12 District Hospitals, 2 Regional Hospitals and 3 Specialist Hospitals in the OR Tambo District.

Please report evidence of this equipment! If there is other equipment that is urgently required, or if the equipment delivered is not required, please report this.

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3. THE EASTERN CAPE IN GENERAL

The Minister’s commitments relate mostly to the OR Tambo District. In the other districts, the national       Department is working with the Province on implementing 287 projects covering new additions, upgrade,     renovation and maintenance work in 132 facilities. A total of 159 of these projects are in the construction   phase while the rest are being developed. They cover 106 primary health care facilities, eight nursing colleges and hospitals. A total of R1.045-‐billion is budgeted for this work up to the end of the financial     year. We are liaising with the Department to obtain more specific information. In addition, the Minister also   committed to:

Equipment
According to the Minister they have information revealing that as of August 2013 the province had a backlog of 2 581 wheelchairs and other “assistive” devices such as hearing aids (703), prosthesis (707) and cochlear implants (2). These will cost R15.3-‐million and will be purchased by the national health     department and dispatched in “the next coming weeks”. Please report evidence of this equipment.

Ambulances
Most of the Eastern Cape has a shortage of ambulances and poor roads in the OR Tambo makes matters even worse. 100 ambulances have been ordered. The minster said the province has agreed to send 26 to OR Tambo as soon as the conversions are completed. No deadline was given. Please report evidence of these new ambulances.

Drug supply
The national Deputy Director of General Hospital Services and Human Resources has been tasked to ensure implementation of a “Development Accord” intended to ensure a reliable supply of medication and equipment to facilities. The provincial department identified 16 hospitals that would benefit from this Development Accord. Committees will be established in regard to various aspects of the plan.

No deadline was given for the implementation of the Accord in the Eastern Cape, but the Minster said the    DDG would follow up and committees would be formed by the end of September. We will liaise further with the Department on details. Please report evidence of implementation.

In regard to stockouts generally, also report to the Stop Stockouts Project at: Tel: 084 855 STOP Fax: 011 728 1251 Email: report@stockouts.org

Procurement reform
Earlier this year the Minster of Finance established the Office of the Chief Procurement Officer. A       Procurement Transformation Initiative (PTI) has been established to develop procurement operations end to end. In agreement with the Minister of Finance, this PTI will be urgently implemented in the Eastern Cape.     The Minister said he envisaged that the teams would be dispatched “very soon” to start with the implementation process. A memorandum of understanding has been signed between the Chief Procurement Officer in National Treasury and the Director General of the Department of Health to facilitate the procurement reform in among others the Eastern Cape.

Management
A new Head ofDepartment has been appointed. The Eastern Cape now has a Chief Financial Officer and a permanent Deputy Director General for Human Resources. The Minister has spoken to the new HOD to prioritise the appointment in the directorate of Pharmaceutical Services. The Minister reported that the       Province has delayed the appointment of hospital CEOs. However, advertisements for a number of new CEO positions in a number of hospitals are being placed in the media.

Please report evidence of these appointments.

Contact ECHCAC via Facebook, our website www.echealthcrisis.org,
Kwazi Mbatha: 0780599309 or Anele Yawa: 073 555 8849, echealthcrisis@rhap.org.za

Remember to always also report stockouts and shortages of medication to the Stop Stockouts Project at: Tel: 084 855 STOP Fax: 011 728 1251
Email: report@stockouts.org

Email: echealthcrisis@rhap.org.za Web: www.echealthcrisis.org
Facebook: www.facebook.com/EChealthcrisis
Phone: Kwazi Mbatha: 078 059 9309 or Anele Yawa: 073 555 8849

Chintsa Secrets

Thursday 24 October 2013

ECHCAC press statement: Request for meeting following non-response from MEC Sicelo Gqobana (Pt. 7 Chintsa For Better Health)

Sunday 6 October 2013

Eastern Cape Health Crisis Action Coalition Update: Volume 1, 4 October 2013 (Pt. 6 Chintsa For Better Health Care)