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
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