SPEECH NOTES: CONSIDERATION OF REPORT OF PORTFOLIO COMMITTEE ON HEALTH ON OVERSIGHT VISITS TO HEALTH FACILITIES AROUND CHRIS HANI DISTRICT MUNICIPALITY

Issued by Nomvano Zibonda, MPL

Madam Speaker. Honourable Premier, Honourable Members of the House, Officials and guests, I greet you all.

It gives me pleasure to present this health report on behalf of Hon Cowley, who is unable to be here today.

The Eastern Cape Department of Health has five strategic goals. The first of these is to provide a functional, quality-driven public health system that is responsive to customer needs. When one travels to the rural areas such as the Chris Hani district, it becomes very clear that this is not the case.

Madam Speaker, not only are the town and rural clinics and hospitals chronically understaffed, but they have many infrastructural difficulties too. These include desperate shortages of space in most clinics, which impacts negatively on patient wellness and patient privacy. In extreme cases, there is NO waiting room at all and patients wait outside, even in extreme weather conditions.

Further challenges include dreadful access roads, which hamper Emergency Medical Service (EMS) turnaround times. In some cases, clinics are simply unreachable during and after rain. Even in the towns, the roads are so bad that one patient had to be pushed to hospital in a wheelbarrow because the ambulance could not reach him.

Madam Speaker, almost all the rural clinics have either no phones, or no connectivity. While most do have electricity, all except one have no back-up generator in the event of electricity failures. This means that medication which should be refrigerated at all times is no longer viable and cannot be dispensed.

So it is clear that the goal of a functional and quality driven health system has not been reached. Patient needs are far greater than the limited services the department can provide.

The second strategic goal is to combat and reduce the impact of TB and HIV/AIDS, with special focus on preventing the emergence of drug resistant strains. Madam Speaker, health practitioners have acknowledged that patients with multi-drug resistant (MDR) TB share the same waiting area as other patients, including babies, in most clinics. There is simply no space for them to wait separately.

Nurses do not have access to suitable transport to trace defaulters and so the default rate in MDR cases is on the rise. Ward Based Outreach Teams (WBOTS) which were meant to improve services in the poorer communities have, according to indicators, not had any positive impact on community health. So as a result of infrastructural challenges, the second strategic goal of the Department remains elusive.

The third goal is that of improving and strengthening mother and child services. I commend the medical staff for the positive impact they have made in this regard. Maternal mortality rates and infant mortality rates have been reduced and while they are still higher than the World Health Organisation norms, improvements are made year on year.

Having said that, Madam Speaker, there is a deeply concerning trend which is rearing its ugly head. The maternal mortality is often a result of haemorrhage, as mothers giving birth are physically not developed enough to do so. They are children themselves. We are all collectively failing these children if we are not taking dramatic steps to educate our youth regarding the many dangers of falling pregnant so young.

While government supports these young mothers, we need to begin thinking of better incentives for girl children who complete their secondary and tertiary education without falling victim to unplanned motherhood, in order to reverse this trend. This will prove to be more cost effective for both the department AND the individuals in the long run.

The fourth strategic goal of the department is to combat and reduce diseases of lifestyle and mental conditions. Madam Speaker, diabetes is on the rise. This disease can often be controlled with healthy eating habits. We must go on the offensive and roll out a massive awareness campaign to educate our citizens about their eating choices.

Patients with mental conditions are seemingly the forgotten people. In most of the institutions that reported on mental health units in their facilities, all of them reported that they are poorly equipped, and sometimes not equipped at all, to deal with mental health patients. How can we combat mental health incidence if we don’t have the capacity to do so?

The fifth and final strategic goal of the department is to enhance institutional capacity through effective leadership and accountability. And herein lies the root of all the problems faced by the department. The ongoing habit of employing people because of their faithfulness to a political party, instead of their commitment to quality health care, has resulted in a collective of upper and middle managers who DO NOT KNOW WHAT THEY ARE DOING.

Funded critical posts lie vacant because of clumsy processes, goods and services budgets are flattened in the first few months of the financial year because of “accruals”, which are now the scapegoat of all financial mismanagement. The contingent liability has grown to a staggering R30 billion because there is no effective plan to deal with it. You cannot continue to rob Peter to pay Paul. Peter will come back and sue you. AGAIN.

Ambulance services are striking, nurses are striking and security is nowhere to be found. Doctors are being attacked and burnt in full view of policemen. Clinic committee members in the Chris Hani district have not been paid a blue cent in three years. Many of these committee members are elderly and walk long distances to attend clinic meetings. This is a disgrace and can only be blamed on managerial incompetence.

When these concerns are brought to the attention of the portfolio committee, district managers tell medical staff not to cooperate with us. This tells me they either have much to hide, or they simply do not understand how government works. Either way, they should not be in positions they clearly cannot fill.

And into this chaos, the national government would like to impose the National Health Insurance or NHI. While we all agree that universal health care is essential, there are many ways to skin a cat. As the proposed NHI currently stands, it is too expensive, too centralised and too clumsy to even contemplate.

What we do need in the Health Department is honest and clean leadership. What we don’t need is cadres who aren’t qualified to fiddle in the affairs of health. What we do need is a leaner and more decentralised top management structure. What we don’t need is a Godfather who has far too much power for his own good.

What we do need in the health department is fairness in progression and reward for excellent service. What we need most of all in health is to listen to the men and women working on the frontline and ensure that they are suitably equipped to do their work properly.

What we need is new and innovative ways of tackling the challenges of rural healthcare. We cannot do things the same way and expect different results. We should learn from our African colleagues, particularly those in Rwanda who are forging ahead in delivery of healthcare to their outlying regions, by using tools of the fourth industrial revolution such as drones and diagnostic apps.

We should also look more closely at health services in the Western Cape. Almost 92% of people living there are within 30 minutes of their nearest health care facility. For those living in rural parts, there is a rural patient transfer network that operates from 230 pick up points across the province to get patients to their nearest facility.

Also, there are 6000 chronic dispensing units, where stable patients can collect their meds which are sent by courier. About 380 000 patients receive meds like this every month. It is no coincidence that the citizens of the Western Cape live longer and healthier lives.

In conclusion, Madam Speaker, what we do not need is a government that constantly looks backward over its shoulder and is incapable of looking forward and planning for a future which has arrived. What we do need is a government that is fair, transparent and accountable and takes the health of its people more seriously than the wealth of its officials. What we need is the Democratic Alliance.

The Democratic Alliance supports the report.