Port Elizabeth health care centres show failing system

On an oversight visit to three Primary Health Care (PHC) clinics in Port Elizabeth this week, I witnessed first-hand how our country falls desperately short of having an efficient, functioning, service-oriented and patient-centered preventive health care system.

I was accompanied by my colleague in the national parliament and DA Shadow Minister of Health, Dr. Wilmot James.  We will accordingly be requesting a meeting with the Eastern Cape Health MEC, Dr. Pumza Dyantyi, to discuss what interventions are being planned to mitigate these needless deaths and illnesses.

South Africa’s disease profile shows that we become ill from, and die of, preventable diseases that are manageable in the PHC-tier and can be treated at a significantly lower cost than at second-tier hospitals. It is therefore at the PHC tier that the bulk of health services should be rendered.

However our visit, to Korsten and Rose Street clinics in Port Elizabeth and Kabah clinic in Uitenhage on Sunday 24 April and Monday 25 April painted a very different picture.

At all three clinics, the staffing levels are half of what they ought to be. A serious consequence of this includes long queues and overworked nursing staff, most visible at Kabah clinic, which services mostly black township residents. Waiting times exceed what should be the norm – often four hours or more.

Indeed, at Kabah, the nursing staff faced crushing pressure from about 80 patients, some with babies and children in their arms, crammed into a small and densely packed hall that ran the risk of promoting clinic-acquired infections in an area that has a high incidence of multi-drug and extensively resistant TB.

But there were clinic-specific problems too. At Korsten clinic, the only one to be open every day of the week from 7am to 7pm, a small dispensary staffed only by a pharmacist assistant rather a proper pharmacist, was closed over the weekend and therefore could not dispense any medication.

At Kabah, the infrastructure needs (more consulting rooms, a proper driveway for ambulances and wheelchair friendly facilities) and maintenance needs (buildings and perimeter environment) are considerable. Staff also require a safe exit when there are riots, the last one of 18 May 2015 having left them trapped and vulnerable.

At Rose Street clinic, located in the inner city of Port Elizabeth, there is no signage at all, the infrastructure is hostile to wheelchairs, the space problems are acute and there is no clear and unencumbered pathway for ambulances to collect patients when the need arises.

The Department of Health conducted a national audit of clinics and released the results in 2012 and found a majority to be seriously wanting. In response, an Ideal Clinic programme, which we most certainly welcome, was introduced to set things right. All clinics are in the process of being audited to see whether they meet the following standards, failing which the department will be expected to invest in capacitating all clinics to meet the following standards.

All clinics must:

  • Have the required administrative processes to ensure efficiency and effectiveness;
  • Have good infrastructure (building in good form, adequate space, essential equipment, information and communication network and tools) to provide required services;
  • Ensure continuity of care through an effective patient information system;
  • Integrate services and functions of the district clinical specialist team (DCST), school health team and municipal ward-based primary health care outreach teams (WB-OT) to improve population health outcomes;
  • Provide integrated chronic disease management (ICDM) and deliver integrated, patient-centered care to patients with chronic diseases, encompassing the full spectrum of care and support by way of the application and use of up-to-date clinical guidelines and protocols;
  • Have the required medicines, supplies and laboratory support;
  • Have adequate staff with the required skills and uphold high standards of professional etiquette;
  • Have a doctor available for the required sessions per week;
  • Cooperate with stakeholders in the community to ensure quality comprehensive primary health care; and
  • Have the required District Health Support Systems available.

But instead of focusing scarce resources on staffing up and having excellent clinics, the national Department of Health goes for a cumbersome, monumentally expensive “Rolls-Royce” National Health Insurance (NHI) that will take 15 years to introduce.

The DA is convinced that it is possible to achieve universal access to healthcare for all within the existing resource envelope with smart and practical reforms. The DA will present its Universal Healthcare for All policy proposals in due course.

On 3 August 2016 South Africans are encouraged to vote for a DA that brings about the change that will deliver better services to all South Africans. This is the change that South Africa needs to move forward again. — Celeste Barker MPL, DA Shadow MEC for Health