Hon. Speaker
Hon. Premier
Members of the House 
Guests in the gallery
Members of the media

Firstly I would like to take the opportunity to congratulate the MEC Motlhaping on his first speech in the Department of Health. Secondly I would like to applaud him and his department on their achievements but I think there is always room for improvement. 

Hon. Speaker, the aim of the members of the portfolio committee is to help the Department of Health to achieve their goals. We cannot just criticize all the time but must also give credit where credit where credit is due. Never did I approach this department with a problem that was not looked into, most of it with a success story - thank you HOD Matlaopane and Chief Director Mazibuko.

Hon. Speaker, section 27 of the South African Constitution provides the right of access to health care services. However, far from the progressive realization of health rights, available indicators suggest a critical decline in the health of South African citizens.

In the Northern Cape in particular, we see an increase in disease. According to the 2014 Stats SA report on causes of death, the Northern Cape was the only province in the country where HIV is now the leading cause of mortality.

We also see how an increase in inefficiencies caused by poor management, are aggravating the suffering of the thousands of citizens who are dependent on the state’s health care system for their wellbeing.

Hon. Speaker, the Freedom Charter as adopted in 1955 clearly states that:

1. Our country will never be prosperous or free until all our people live in brotherhood, enjoying equal rights and opportunities;
2. Provide free medical care and hospitalization for all, with special care for mothers and children.

Hon. Speaker, I would like to quote something by Thomas Carlyle:
“It is better to be healthy than rich since ill-health makes a person unhappy even though he is rich. This is a consolation to the poor who can very likely achieve good health as easily as the rich can”.

Hon. Speaker, I am very concerned about current state of Kimberley Hospital.

As I speak, I am aware that Kimberley Hospital has run out of walking rings. As a result, patients who undergo hip, knee and leg surgery are advised to purchase their own walking rings so that they can be safely mobile, or otherwise face the risk of undoing the operative procedures that they waited so long to undergo. 

We are speaking of the poorest of the poor, who can barely afford to buy bread to put on the table, let alone spend a few hundred rand on a walking ring.   

About four weeks ago, certain antibiotics were of stock at Kimberley Hospital. This placed patients who underwent surgery at risk of developing sepsis, as prophylactic antibiotics are given as a preventative measure after operations.

At around the same time, there was also a shortage of suction liners that are essential to suck up blood so that surgeons can see where they are operating. As a result, only life threatening cases were operated on.

Then the hospital ran out of cautery pads, needed to cauterize in order to stop bleeding. Once again only life threatening operations were conducted.

About six weeks ago, the Kimberley Hospital also ran out of washing powder. This in turn meant that the hospital had no clean linen so the hospital once again stopped non-life-threatening operations because sterile drapes are needed for operations and instruments need to be wrapped in clean sheets to be sterilized.

Before I proceed I want to categorically state that these are not reports that I picked up from the media. These reports come directly from people who witnessed these resource shortages.

I want to warn the MEC that hospital management is pulling the wool over his eyes and that if he is serious about making inroads in Kimberley Hospital, then he needs to start speaking to the doctors, nurses and patients at a grassroots level. 

Kimberley Hospital is at risk of non-compliance to the Tertiary Hospitals service package due to staffing and budget and faces the possible discontinuation of services, which in turn threatens its Tertiary Hospital status. 

Two weeks ago, the hospital CEO himself conceded to the legislature portfolio committee that KH was in dire financial straits, as the hospital had run out of money and had stopped paying suppliers and hence suppliers had stopped delivering.

This is not the picture of an efficient health care system. This is the picture of deficient planning and poorly informed decision making. 

Look for example at the relocation of the two theatres from KH to the Curomed building. This move was apparently meant to be cost-neutral but ultimately caused the department to overspend and now it adds additional financial pressure to the already burdened health care system.   

If this government can’t even manage its current health portfolio, what then of the National Health Insurance, which will see this department having to manage an even greater pool of money?

This poses a concern on another level as well.

On instruction from Treasury, the department is busy switching over to the LOGIS system for all procurement. The implementation of LOGIS within the provincial health system, however, faces two direct challenges.

Not only does the implementation of LOGIS require adequate ICT connectivity but it also requires a sufficient number of trained staff, based on the built-in segregation of duties in order to curb fraud.

This is all good and well, except for the fact that this department doesn’t have sufficient funds to upgrade its ICT network, nor does it have enough funds to appoint the number of administrative personnel required to ensure that LOGIS becomes operational.

In the words of the department, “this is going to be a mess”.

This certainly doesn’t instill any confidence in procurement processes going forward.

This is deeply worrying, given that the De Aar hospital and mental hospital are scheduled to be completed this financial year and require major procurement in order to properly equip these facilities.

This would be a problem, if the department actually had sufficient funds to enable the procurement. Ironically, however, it doesn’t.

The department currently does not have a budget to operationalize either the De Aar hospital or the Mental Hospital nor can it staff them.
   
After more than 10 years spent on the mental hospital and R1 billion later, this is inconceivable.

But even more mind-boggling is the fact that the new mental hospital is so long overdue that what was intended to be classified as a state-of-the-art facility is already outdated, in spite of it being brand new.

I say this against the backdrop that the philosophy underpinning mental health has changed from a centralised to a decentralized approach, meaning that the new facility may in fact be too big.

In hindsight, what this department should have done was establish psychiatric units at existing facilities across the province.

Last year, the Western Cape government opened such a facility at Paarl Hospital at a cost of R35 million. If you do the sums, the Northern Cape could by now have enjoyed the services of approximately 30 psychiatric units, each with 30 beds, scattered across our vast province. 

But it’s no use crying over spilt milk and the department will now have to come up with an innovative plan to ensure that the huge, new facility is optimally utilized to the benefit of mental health care for everyone living in the Northern Cape. 

The same applies to the TB Hospital at West End, given that there is also a process underway to decentralize TB services countrywide.

Hon. Speaker, in speaking about health facilities, I wish to pronounce my concern that Prieska Hospital is the only hospital in the Northern Cape that is compliant with the Extreme Measure of National Core Standards, while zero Primary Health Care facilities in this province are compliant with these standards.

It is therefore not surprising that personnel and patients are increasingly exposed to Drug Resistant TB because of poor infection control measures. Nor is it surprising that hospital acquired infections are also on the rise, with a total of 46 such cases reported between April 2015 and January 2016.

The challenges that stand in the way of clinics achieving Ideal Clinic status must be urgently addressed. This said, the funds committed by national to assist the department to purchase half of the medical equipment required in order to ensure full operationalization of the facilities that are targeted to become ideal clinics, must be wisely spent. 

Hon. Speaker, now more than ever before, this department needs bucket loads of wisdom and top notch leadership to rescue it because currently this department finds itself in the midst of an HR crisis:  

1. The department has failed to stabilize the high vacancy rate of medical officers, medical specialists, professional nurses and pharmacists, amongst others. 

2. At last known date, the department had only one forensic nurse operating in the entire province, in spite of the high rate of sexual offences in the Northern Cape.

3. TB tracer teams and the school health programme are also not performing well due to a shortage of professional nurses.

4. And emergency Medical Services further continue to be plagued by single crew ambulances.

5. At the same time, most nurses in the Northern Cape don’t have a Primary Health Care qualification that is a requirement in Occupation Specific Dispensation and hence require further training, while most emergency care practitioners also need to be up-skilled. The province, however, does not have the capacity to achieve this.   

The department also finds itself in a service delivery crisis:

1. The EMS College faces possible loss of accreditation as a training facility due to the department’s inability to appoint high skilled lecturers, as well as a lack of telephones and internet connectivity.

2. Forensic Medical services face the potential risk of discontinuation due to the failure by the department to implement Forensic Pathology Service Guidelines at mortuaries, as well as failure to provide clothing and cleaning chemicals at facilities and the installation of generators and fridges at facilities.

The list goes on and on but I think you get the picture.

On the bright side, there are a few initiatives, such as former MEC Jack’s establishment of an anti-corruption task team, that deserve a commendation.  

But while such initiatives should, over the long term, assist the department to decrease its accruals, they are not enough to heal this very sick department.  

Instead, this department needs a chronic prescription for sensible planning, astute financial management and shrewd decision making.

In closing allow me wish the MEC and his department well in their endeavours to tackle the multitude of challenges facing the health department. I firmly believe that if this department makes the sick and injured their number one priority, they will finally get off on the right track.

Thank you.