Department response to Mpumalanga oversight recommendations; Limpopo and Mpumalanga progress on oversight recommendations

Meeting report

Report back on Committee recommendations: DPME

Mr Henk Serfontein, Chief Director: of Public Service Monitoring, Department of Planning, Monitoring and Evaluation (DPME), said that the first issue raised by the Committee during its oversight visit was the signing of performance agreements by the Heads of Departments(HODs) of the provinces. The DPME had received a 100% success rate for the signing of performance agreements, but one HOD in Limpopo had submitted late.

Another Committee recommendation was that the Department should include 30-day payment and key priorities in the performance agreements, to strengthen the structure and content of these agreements. One of the challenges in implementing this measure was that the revised policy was still outstanding. The review of the 2016/2017 cycle would be completed by December 2017 and the DPME would report on whether the evaluations were done to the Committee in early 2018.

The Committee had commented there were contrary reports between the DPME and the Public Service Commission (PSC). The difference had arisen due to the different methodologies used by both institutions -- how and what they assessed. The DPME could not influence how the PSC assessed certain issues, as it was a Chapter 10 institution, which was an independent body. However, it had tried to align its information with the PSC and remained in contact with the Commission in order to utilise the same information and reduce duplication of data.

He said the DPME supported the Committee’s recommendation that executive authorities should ensure payment of suppliers within 30 days to be part of the performance contracts of the Heads of Department. However, it was currently difficult to ensure the 30 day payment recommendation aligned with the draft Performance Management and Development System (PMDS). The DPME did stress the need to pay suppliers within 30 days during its various engagements with its departments and the premiers. In the absence of the PMDS policy, the DPME was using other avenues to encourage departments to pay their suppliers within 30 days. One of the departments failing to pay its suppliers within 30 days was Health.

The DPME had a unit which focused on the issue of ensuring suppliers were paid within 30 days. This unit had facilitated the outstanding payment of suppliers and had reached to a cumulative amount of R327 million. The unit had focused on the processes, products and improvements of the current processes of invoices and payments, and now had the challenge of addressing tougher problems such as cash flow. The DPME was awaiting the PMDS policy in order to address the 30 payment issue and include it in the performance contracts with HODs and accounting officers.

Discussion

Mr S Motau ( DA) said that a point the Committee had repeatedly raised with the DPME was that for as long as the Department pleaded, encouraged, cajoled and urged these departments to do what they were supposed to do, there were no consequences for non-performance. The DMPE and the Committee would constantly meet over the same problem. He asked if the Department had any plans to give itself some “teeth"? The PSC and the Auditor General (AG) faced a similar problem, and the Committee was looking at how it could give the AG some "teeth". As long as departments knew that all these organisation could do was talk, nothing was going to happen.

The Chairperson said that the Department of Public Service and Administration should note Mr Motau’s question, and the Committee would allow PSC to present on this issue as well. 


Response to Committee recommendations: DPSA  

Mr Willie Vukela, Acting Director General: Department of Public Service and Administration (DPSA), said that the recommendations made by the Committee were crucial for the Department to enforce the principles of the National Development Plan (NDP), which aimed to improve public service. The recommendations also assisted the DPSA to ensure that section 195 of the Constitution was realised and that its policy was effective and able to respond to the needs of the citizens.

Ms Veronica Motalane, Chief Director: DPSA, said that after the Committee’s oversight visits to Limpopo and Mpumalanga, there had been inter-departmental meetings between the DPSA, the Department of Planning, Monitoring and Evaluation, the National School of Government and the respective provinces over the generic findings and recommendations made during the oversight visit.

During the Committee's visits to the provinces, presentations were made on the state of the province, service delivery improvement programmes run by the DPSA, and management of performance assessment tools by the DPME. The sites visited included the Thusong service centres (TSCs), hospitals, and National Youth Development Agency (NYDA) offices in the province. Key issues looked at had included the service delivery environment in hospitals, the management and governance arrangements, queue management procedures and systems, complaint management processes and the operations management in the TSCs and the NYDA.

The Committee and departmental delegation had visited the following sites:

• Limpopo: The NYDA, Polokwane, Moletije Thusong Service Centre, Mankweng Provincial Hospital, and WF Knobel District Hospital.
• Mpumalanga: National Youth Development Agency, Emalahleni, Phola Thusong Service Centre, Casteel Thusong Service Centre, and Matikwana District hospital

The Committee's generic findings made from the oversight visits included:

• The need for ongoing support and continuous improvement in the operations and governance arrangement of the health sector;
• The need to address water challenges faced by Mpumalanga Health, as the department used its maintenance budget to fill-up Jojo tanks;
• The need for new and repair of infrastructure, as the hospitals visited by the Committee had maintenance issues and were very old;
• The need to address filing and document management, as it affected the turnaround times of operations. During the visits, doctors had complained that they had to address issues of administration before they attended to patients.

In addition, the Committee had made recommendations that:

• The DPSA urgently strengthens the integrated approach for government interventions, through improved support for the Thusong Service Centre Programme. This would address the challenges of maintenance, lease agreements, and ownership and funding of the centres faced by the programme.
• The Thusong Service Centre programme was now part of the Outcome 12 programme of action, with regular monitoring and reporting. The policy directive would ensure that citizens had access to the centres.
• A multi-stakeholder conference on Thusong Service Centres should be held to ensure that there was improvement of services. There were current processes, such as consultations and engagements with relevant stakeholders, occurring as a build-up to the conference. The DPSA hoped to host this conference by February 2018.
• The NYDA needed to strengthen its visibility and accessibility across the country, especially in rural areas.
• Equity targets for senior management services for women and the mainstreaming of disability in the public service required urgent and sustainable interventions.

Ms Motalane summarised the achievements. On the recommendation that the executive authority ensure payment of suppliers within 30 days, and that the 30-day payment requirement be part of the performance contract of HoDs, the Limpopo Health Department had developed an electronic payment system and a 12-month learnership for unemployed financial graduates to strengthen the payment for suppliers. Mpumgalanga HoD's had developed the Siyabhadala system, which monitored overdue account payments. Both provinces had taken note of the misalignment between budgets and performance targets.

The implementation of service delivery improvement programmes was in line with annual performance plans, resource allocation and the display of the service charter in both provinces. There was 100% compliance of submitting the performance plans, but the quality and monitoring of the Service Delivery Improvement Plans (SDIPs) remained a problem. The DPSA had held workshops and provided ongoing support to the departments and provinces, so as to improve the quality of performance plans guiding the SDIPs.

Under improving the turnaround time for emergency services, Limpopo had implemented a vehicle management system to ensure that all ambulances were monitored at all times and were identified within a close proximity.

On the  recommendation that accounting officers should ensure signed performance agreements aligned to the delivery outcomes and must be evaluated accordingly, Mpumalanga had concluded HoDs’ performance agreements and evaluations for 2016/2017 in July 2017, and the 2017/2018 performance agreements and evaluations would be completed in November 2017. In Limpopo, majority of the HoDs had not completed their evaluations for both 2016/2017 and 2017/2018.

Regarding the recommendation that the DPSA should report to the Committee regarding its strategy to deal with the backlog in the public sector in the third quarter of 2017/18, the DPSA would follow up and give a presentation to the Committee.

Ms Motalane said that the employment equity for both provinces was low, as in Mpumalanga there were 121 women in senior management service (SMS) posts in comparison to 214 males. There were five provincial departments which met the 2% threshold for people with disabilities, while seven had not. Mpumalanga’s Departments of Health and Education had the lowest number of staff with disabilities. Most departments in Limpopo had met the 2% target for the employment of people with disability, and a 3% target for persons with disability at the SMS level.

The DPSA had developed precautionary suspension and sanctioning guidelines to ensure prompt and consistent application of discipline in the public service. In addition, it had reviewed the disciplinary code procedure for the public service, which outlined the timeframe for disciplinary processes and cases of precautionary suspensions.

She said that the strategy for the maintenance of government structures had been developed, and priorities set for service delivery departments such as Health and Education. Mpumalanga had indicated that a school for the deaf would built in Mbombela, and construction would start in 2018/2019.  Mpumalanga had allocated R10 million per district for the maintenance of hospitals, and it would outsource its laundry services. The current operational and budget challenges faced by Matikwane Hospital had come from the province taking over the public-private partnership which previously ran the hospital. The province had created a task team to address all the issues raised by the Committee about the Matikwane hospital, as it was not on par with other hospitals in Mpumalanga. Mpumalanga had increased its medicine supply to hospitals from 89% in 2013/14, to 92% by September 2017, while in Limpopo, the medicine availability at hospitals was 92%, and 88% at the primary healthcare level, as at September 22.

She said that the W F Knobel district hospital faced infrastructure challenges, and the provincial administration had a plan to address the dire state of the hospital which would be implemented in the next 24th months. The Polokwane hospital had purchased the correct missing parts, and new parts for the Bucky table, which had been unused. 

A business case for a consultative conference between stakeholders and improvement plans had been developed for the Thusong Service centres. These measures aimed to address the functional frustrations of the centres, and modernise them.

The DSPA was reviewing its current recruitment strategy and developing new staffing norms across all health facilities. The Provincial Department of Health's budgets were being strained by assisting patients from other countries. The departments were signing memorandums of understanding with neighbouring countries such as Mozambique, Swaziland and Zimbabwe, to address all cross-border health issues.

The Department of Health had advertised 551 posts to fill low category staff positions in facilities, but it had concerns over the quality of staff which could fill these posts.

The DPSA would deploy staff to help affected hospitals with filing and administration issues in order to improve the turnaround time for doctors. The Mpumalanga DoH had put in several systems, such as a record management policy filing system, optic plan focusing of patient files, and a health patient records system to focus on medical records. Matikwane hospital had procured new filing cabinets.

Mr Emmanuel Kgamo, Acting DDG: Service Delivery, DPSA, said the DPSA had informed the NYDA  that it should have mobile units for areas surrounding Polokwane so as to have greater reach. People who used the Thusong Service Centre located in Moletjie were not aware that the local traditional leader did not own the centre, even though he maintained it . The Department was worried about the sustainability of the relationship between the traditional leader and the community, as it expected him and not the Department to provide the relevant services.

Dr Phophi Ramathuba, Member of the Executive Council (MEC): Health, Limpopo said that the Limpopo Department of Health (DoH) was always behind in the payment of suppliers because it was under-funded. The DoH had engaged the National Treasury and asked for a health economist to assist in managing and designing its budget, as towards the fourth quarter the Department could not pay for its suppliers but still made orders for oxygen. The Treasury had given the Limpopo DoH three chartered accountants to assess if the itwas under-funded or whether there was a wastage of funding.

She said that the Limpopo DoH was correcting its internal systems for pharmaceutical services as suppliers now issued invoices at the depot and were verified by the department's purchase vouchers. She added that SMS learners were B Com students, who analysed the pharmaceutical invoices at the drug depots. She added that the Department faced a serious challenge with rising drug prices, and sought assistance from the Committee to assess if the escalating price increments were lawful.

The DoH had negotiated for funding of new systems to monitor and manage ambulance services, as there had previously been a lot of wastage.  It had developed a policy which stated that no new hospitals would be built in the next 18 to 24 months. It would maintain and fix current buildings in order to retain critical staff and boost morale. The DoH had established an equipment committee, which consisted of various specialists who would choose standardised equipment that could be used by all health professionals.  In addition, this equipment must come with a maintenance plan.

The Limpopo DoH had established a relationship with the Department of Home Affairs to improve its filing system and aimed to gain access to the ID number system. This system would enable hospitals and clinics to attach patients’ records and tests results to the barcoded IDs. She added that the system would assist the Limpopo DoH address the challenge of drug smuggling to neighbouring countries and drug shortages in public clinics.

She said the DoH's employment structure placed a strong emphasis on managers and not enough on frontline employees. The Limpopo DoH's turnaround strategy included removing and realigning posts of retiring Deputy Director Generals  and hiring more qualified cleaning, maintenance and catering staff. The Limpopo DoH was also hiring Chief Executive Officers (CEOs) with health and managerial backgrounds to run hospitals in order to improve hospital services and the morale of staff members.

Ms Ningi Mlangeni, Deputy Director General: Compliance, Office of the Premier (OTP), Mpumalanga, said that province had developed a turnaround strategy for Matikwane which had resulted in the installation of geysers and laundry equipment, painting of the hospital, new monitoring and filing systems, new queue marshals and the restructuring of senior management. The compliance office in the provincial office was looking at all issues facing service delivery and would ensure compliance of the recommendations made by the Committee and the DPSA. The province had conducted three quick assessments of all hospitals in 2012, 2016 and 2017. The 2017 quick assessment would be completed by the week of 20 November.

Discussion
Ms D van der Walt (DA) complained about Committee Members’ treatment during the oversight visits as employees of the two provinces had thought that they were doing the oversights. Only after complaining to the Committee's Chairperson that members could not hear or see what provincial employees' were explaining, did employees give Members the space to conduct their oversight functions.  Officials from the departments and provinces must understand that the visits were Committee Members’ oversight, and officials must respond to the Committee's questions. She said that in Mpumalanga there were some officials who had never been to the visited sites. Given the current austerity measures, delegations should consist only of officials who were needed and could respond to Member's questions. She also commented on the ill treatment of the former Chairperson, Dr Makhosi Busisiwe Khoza, by certain politicians in Mpumalanga and said that it was unacceptable, given the good work done by the Committee.

She said that the Rob Ferreira Hospital in Mpumalanga had been in the news again about its laundry, yet these issues had been raised in the Committee's oversight visit eight months ago. While the province had made some improvements, some hospitals still had the challenge of no washing machines, tumble driers or areas to wash and sterilize the laundry. The Mpumalanga DoH had recently bought machines, but the laundry room would be operating only sometime in 2018. In the meantime, the laundry at Rob Ferreira Hospital would remain an issue, even though patients needed clean, hygienic laundry.

She commended the Limpopo MEC for Health for maintaining constant communication and informing her about matters of the hospitals in Limpopo. She said some of the medicine in the Seshego depot had expired past its use date, and that this problem had existed for some time. Tthe cooling conditions were not good enough for the medicines, and there was an alleged incident of a child dying from stale medication. There was a need to give people medicine that made them healthy by ensuring that the cooling facilities were proper at Seshego, or finding another deport.

She said that the air conditioners at the heart operating room had caused one of the machines not to work during the oversight visit and had affected the patients’ oxygen supply, as they inhaled unsterilised air. She added that there was good equipment not being used in the hospitals. The emergency services of Limpopo had at least 2 000 workers, but only 25 were qualified to deal with emergencies and make use of the ambulances. During the Standing Committee on Public Accounts (SCOPA) hearing, it had been stated that 68 women had died whilst in labour. Was this the truth and what was the reason? Was it because of untrained staff, or the equipment?

She said that buying filing cabinets in both provinces was going to make the hospitals neater, but would not solve the problem. There should be investigations on how to get a computerised system. Limpopo previously had such a system. The Committee had found during oversight visits to hospitals across the country that some patient’s files could simply not be found. A cabinet would not solve the issue, but a bigger and better system, where doctors could see the complete history of the patient, would address the problem.

She asked if poor people in Limpopo were obliged to pay for the release of their deceased loved ones. She understood the various challenges facing the morgues, such as overloading and space, but said that it could not be that one had to pay R1 600. She asked if this was not the law, who took the money.

Mr Motau said that at one of the visited hospitals a dentist’s chair had been standing there in disrepair for two years, and had not been fixed. Why not? He commented that when a hospital had equipment that was broken or not repaired, people would say it was because of wrong specifications. In the South Africa of today, his first reaction would be that it was not a mistake, but that somebody had probably made a wrong order so another person would benefit. Did the Provincial DoH follow up on these issues? People did not make mistakes like wrong orders, because South African society was plagued with corruption.

He commented on the top heavy structure of hospitals, and said that most people wanted to be DDGs or MECs, and not junior managers. He commended the Limpopo DoH for picking up on this issue. He said the problem of multiple dipping of anti-retrovirals (ARVs) had affected the Department of Health for many years and it was good that Limpopo was addressing it. He added to Ms van der Walt’s complaint about the Committee's treatment during the oversight visit, and said that he took personal offence when a Member of the Committee gets threatened by a functionary of the state. The treatment of the former Chairperson, Dr Khoza, should never happen again.

The Chairperson asked the delegations if they knew which hospital had the broken dentist’s chair.

Mr Motau replied that the departmental and provincial members did not remember, and informed the Committee that it was at Matikwane hospital in Mpumalanga.

Ms W Newhoudt-Druchem (ANC) had initially wanted to ask about the filing system, but the Limpopo MEC had responded about using the ID number system to gather patients’ information. When the DPME worked on frontline systems, would it ensure that the ID system could be rolled out in all hospitals and clinics? She asked if the approach taken by the Limpopo DoH would be applied in other hospitals.

She referred to the 63% male to 37% female staff ratio in Mpumalanga, and asked if there were any future plans to ensure that a 50/50 ratio was achieved. She could not find the gender figures for Limpopo and asked if the province could enlighten her on what the figures were.

She said that many years ago, the Deaf Federation of South Africa used to transport deaf children from Mpumalanga to a school in another province,at its own cost. Currently, the Department of Basic Education had taken over from the Deaf Federation to provide the service. There was no high school for deaf children in Mpumalanga, and asked who took responsibility for this situation. She acknowledged that the provincial government was building a new school, but asked where the deaf children were currently going to school. Who was providing them with transport? It was a heavy task for parents to provide the transport.

She said that the NYDA had previously presented to the Committee on the high level of children without matric, and she had informed it that deaf children would add to this high percentage, as deaf children were struggling to get a matric throughout South Africa. The Committee knew the NYDA was usually in the urban areas, and it had informed the Committee about its mobile units. She was aware that most premiers had youth desks, but the NYDA had informed the Committee that these youth desks did not follow the NYDA's objective or goals. She asked about the relationship between the NYDA and the premier’s office. How could it be made better? Youths in the rural areas should get information from the youth desks, as they could not travel to the NYDA. Could youths get relevant information from these youth desks?

Ms Lesoma said that she appreciated the MEC informing the Committee of the Limpopo DoH’s work and challenges. She would have appreciated it if the DPSA and DPME could have added the action dates for the turnaround progress given during their presentations. Something that was not measureable had an open ended action, which became an ongoing concern. She added that the issues affecting both provinces were largely operational issues, and the Committee would love to close these problems. Target dates were important, as they assisted the Committee to make follow ups.

She said that transformation was not just about addressing demographics, but also about placing the rights skills in the right positions. This spoke to the issue about hospitals and institutions being managed by the right professionals. Transformation should include doing work faster, smarter, better and with acceptable quality standards. While gains had been made in racial transformation, there was a need to address gender and people with disability. She asked if the DPME could monitor both forms of transformation mentioned and give the Committee a progress report. 

She agreed with Ms Van der Walt about the filing system, and said that the problem was not filing cabinets. Years ago, the state had rolled out the E-government programme, and the Committee had informed the DPSA that its information technology (IT) system left a lot to be desired. The DPSA must upscale its IT system, and at a national level, up scaling of the system involved the Treasury. The DPME should report to the Committee on the progress of negotiations with the Treasury to run this upscaled programme on Pascal, and the monitoring of senior management.

She appreciated the progress reported in the Department's response to the assessments of senior management. She asked if the DPSA could give the Committee the progress on the executive authority of the Directors General, as there was a spill over to other spheres of government. If the Department did not get it right now, it would become a problem in the future.

Ms Lesoma commended Mpumalanga on its progress, as in 2015 there had been a public hearing which had addressed the impact of 30-day payments to suppliers. The hearing had revealed the damage that government did to small businesses. For a while, there had been a big drive towards promoting small businesses and creating jobs. It was unfair that government entities did not pay suppliers within the 30-day period. It was important to address this, and state departments should freeze their captured budget spending.

Before the House rose at the end of the year, the Committee should look at how it could squeeze the Department of Public Works (DPW) into its Committee programme, in order to assess how it could manage public facilities. The DPW had outsourced this responsibility, but it would be interesting to engage the Department and address the challenges faced by the provinces. 

The Committee did not expect all the answers from the delegations today, but they should respond in writing. She had an issue with officials who thought that service delivery improvement plans were outside their general work and required separate funding. This situation arose because the departments and provinces had not implemented the predetermined objectives and three and five-year plans. Government required that public service bodies had these plans, and they should be incorporated into the performance agreements. She appreciated that the MEC acknowledged that not all problems required additional funding and that departments face these problems because they did not implement their improvement plans.

Ms Lesoma added that during the Committee's oversight visit, the Members had had lunch in a “first class hospital". Unfortunately, there were no communities around this first-class hospital. When the Department had built the hospital, it had come short on the feasibility study, and could not expect a community to rapidly grow and get sick to use this remote hospital. The hospital had equipment and staff, but it appeared to be more of a restaurant than a hospital. She appreciated the fact that the Limpopo DoH had developed a policy to stop building hospitals, in order to take into account operational costs such as equipment and human capital having impacts on finances, especially when these costs were not budgeted for. It was important to build structures with the consideration of these costs and communities, to ensure that hospitals were utilised.

The Committee had noted the non-performance and low appetite of internal audit committees. If these audit committee were well used, issues raised by the Committee during the oversight visit would have been picked up by the internal auditors. Provinces should look at the role and function of their auditing and legislative committees in terms of oversight.

The Committee would appreciate seeing the business plans for the programmes suggested by the MEC of Limpopo, and for the DPSA to develop a measure to compensate the traditional leader and other traditional authorities for providing services at Thusong Service centres.

The Chairperson responded to Ms Lesoma’s comment, saying that the “first class hospital” was in the Free State and not in the two provinces presented. He added that traditional chief housing the Thusong Service Centre was Chief Kgoshi Moloto, in Moletjie.

Mr M Khosa (ANC) said that while he had not been on the specific oversight visits, he took constituency work as oversight. He requested all departments to respond to questions raised by Members during their constituency work. Before the Committee went to Matikwane, he had visited the hospital but had been unaware that the Committee would conduct an oversight visit. He had informed the CEO of Matiwane Hospital during his personal visit of all the issues raised by the Committee.

He added that the Committee was not able to address all the problems facing communities during oversight visits. There was a clinic next to Matikwane which kept its medicine in a facility that did not have a fan or air conditioning. The area was very hot, with temperatures of 40 degrees. He had pointed out this problem to the local department and left his contact details, but was yet to receive any communication from the local health department or the clinic. Maybe once the Limpopo Department of Health informed the clinic about this problem, the Committee would receive feedback and be taken seriously,

Accessibility for people with disabilities was a challenge at Casteel Thusong Centre. How was this being resolved? Regarding the Short Message Service (SMS) system for ambulances, it was one thing to respond to a call but another for an ambulance to arrive to pick up patients. The ambulances took a long time to arrive at incidents.

Mr Khoza asked how long it took for departments and provinces to address the issues raised by the Committee? The Committee meeting had happened in March, but these delegations were responding now that the various departments were seeking to address issues. He asked if the DPSA could inform him on its progress with the maintenance of public facilities by the Department of Public Works and the Department of Water and Sanitation.

He appreciated that the MEC had responded that the challenge for the Limpopo DoH was not funding, but how to utilise the available funds. He asked if there were any plans in place to ensure that personnel were well trained to do their work in a correct manner. Did the province have internal audits? How effective were these audits? Were they assisting the Department of Health? If the Limpopo DoH did not have internal audits, it should establish them.

Ms Z Jongbloed (DA) added to Mr Motau’s comments about the “doubling dipping” of medicine, and said that it was “multiple dipping.” During the Limpopo MEC of Health's presentation, it had been stated that multiple dipping of medication had an impact on the DoH's resources, as people came across various borders to get drugs from the clinics. Did the provincial health department have other interventions to prevent people from doing this?  She acknowledged that the MEC was dealing with the top heavy structures, and the need for more frontline staffers.
 
Mr M Ntombela (ANC) was pleased that the provinces had responded to the Committee’s call to report on the oversight progress. He asked if there had been collaboration between the DPME and the PSC. He believes that these entities might have conflicting reports, as the manner in which they collected data might be different. The PSC should have its own investigative strategies, which had their own objectives. 

He asked for the details on the water issues in Mpumalanga, where the budget for maintenance had been spent on filling the JoJo tanks with water. The water tanks required maintenance as well. He said the Committee should be informed not just about the steps taken, but the process in which the steps were taken to achieve 30-day payment of suppliers. He asked the DPSA and province of Limpopo who managed the Siyabadala project. What exactly did it do?

He said that the DPSA's presentation set a target of 90's for the Service Delivery Improvement Plans (SDIPs) by 2019.  He said that optimal target was usually 100%, so why did the Department aim for 90%?

He asked if both provinces compared with other provinces emergency services. Did they compare good practices from other provinces? From where he came from, the Free State, the emergency medical service (EMS) was a disaster, but it did not have to be this way. It was important to know how these provinces compared, so that the Committee got a global picture on emergency services in the country. He thought that Mpumalanga had always been progressive, but the staff gender ratios showed that women were at 36%. Other provinces were gunning for 51% and 50%, and Mpumalanga was lagging behind.

Mr Ntombela said that from the presentation, it appeared that since oversight visit to Matikwane, the hospital was improving. He asked if the DDG from Mpumalanga could tell the Committee of the actual progress of implementation to the Matikwane and Knobel Hospitals. Something ought to have happened, since the visit had been in March. The impact from implementation could be small, but it was important that the Committee was made aware of it. The DDG had reported on the plan and the progress of the plans, but he had asked what had happened, and not about the progress of plans. It was very discouraging when municipalities which were confronted with problems of sewage or leakages, responded with "we have planned 1,2,3,4".

He asked if the provinces had made efforts to encourage the local municipalities to collaborate with the NYDA. The NYDA had informed the Committee of its plan to engage municipalities and provinces to set up youth offices. He asked if the provinces would help the NYDA to improve its visibility and service delivery to its constituencies.

He said the Limpopo MEC had made mention that there were doctors who were wrongly placed in the hospitals, and this was a serious issue. He did not understand why non-medical doctors were placed in hospitals, and asked for clarify on this issue. In Mpumalanga there were quick assessments, and he asked if the quick assessments were about the performance of hospitals. He observed that the gaps between the quick assessments were about four years, and asked the reason for these gaps.

He thought that the report would speak about Lethebo Rabalago, the “Doom” prophet, as there was a court case involving him and Dr Ramathuba. This incident had had an impact on service delivery.

The Chairperson said the Committee should take responsibility for its meetings and proceedings, and should take appropriate measures during its Parliamentary operations. This also applied to its oversight visits, and the Committee should have taken appropriate steps against the mistreatment of former chairperson, Ms Khosa. The DPSA, DPME and the provinces should understand that the Committee could not conduct oversight over all the provinces, so the departments had to check that their systems were in place throughout the country.

It was unacceptable that the DPSA had refused to approve the DPME’s organogram for a period of over seven years. The DPSA must meet the Director General of the DPME to look at the issue and send Minister a copy of the organogram so she could put her signature. He lamented that the DPSA could not expect a capable development state to be operational if the DPME's organogram had not been approved.

He said that the DPME had responsibility for the NYDA, but had not spoken more about its role with the NYDA. It must ensure that youth affairs were central to monitoring and evaluation.

Mr Khosa said that the Committee would have expected Dr Gillion Mashego, the MEC of Health for Mpumalanga, to explain why the former Committee chairperson had received the alleged mistreatment during its oversight visit in March. Until Dr Mashego attended a Committee meeting, comments made on this matter would remain pure speculation.

The Chairperson said that the Committee would not call Dr Mashego to attend a meeting, as Members had to deal with issues when they arose, and not months after the incident.

Ms Lesoma said that in 2018, the DPSA should make a presentation to the Committee on the process of the suggested structure for the public service throughout the country.

Departments’ responses

Dr Ramathaba replied that in 2011, the Limpopo Executive Council had made a decision to build the Limpopo DoH's pharmaceutical depot. However, this decision had been overturned by the National DoH as it had put a moratorium on municipal district depots which were yet to be implemented. There was a need for a new depot, but the Medicines Control Council (MCC) had not granted the Limpopo DoH a licence to operate this new infrastructure. However, the province was addressing the challenges faced by the current depot, as it sought to fix the roof and air conditioning. The Department had submitted its request to the Executive Council, but the process may take 18 months and this may be a problem if the province experienced serious rains or a storm. There needed to be swift action to a build a new depot, and there was an identified site for the new structure. It was important to improve the condition of the depot, as it hosted R108 million worth of pharmaceutical drugs.

According to the Limpopo Uniform Payment Fee Schedule (UPFS) tariffs, the province stores corpses free of charge for a period of 48 hours. The province calls the deceased's kin, informs them that the body would be kept for free in storage for 48 hours and gives them the option to use the provinces or their own undertaker. In the event that the next of kin uses the services of the provincial undertaker, they are charged for services after 48 hours, if the it was a natural death. Forensic bodies went through another process, which included the police. Limpopo had a serious challenge of unclaimed corpses as there were at least 200 unclaimed corpses in the different municipalities, and the DoH sought to gives these corpses a pauper’s funeral. However, this was a long process, as the Department had to get approval from the police and this could take up to two years.

She said that there were different categories of emergency services personnel, and the province had not balanced out these groups. The first category was the basic ambulance assistant, who went through a four-week course, which the Limpopo DoH hoped to phase out. The second category was the basic life support personnel, who went through a four-month course, while the third category were the advanced life support personnel, who were the paramedics. The province had a serious challenge with the advanced life support personnel, as there were only 25 in Limpopo. There were 600 intermediate life support personnel, who could attend to priority two patients, while basic life supporters could attend to injuries that were not major, and were critical for transporting and transferring stable patients. The provincial DoH had informed the Treasury that it required funding to revamp the Emergency Medical Services College and train people to become advanced and intermediate life supporters.

The DoH had been questioned by SCOPA about outsourcing ambulance services, and it had informed it that the Department had only 25 advanced life supporters, who could not attend to all of the incidents such as accidents in Limpopo. There were women who had fits during childbirth and had to be transferred to senior hospitals. This situation required an advanced life supporter and it was hoped that the revamping of the Medical College would increase the number of life supporters who could attend to serious medical incidents. The province had seen a reduction in maternal morality, as it used to be 182 deaths per 100 000 births, and was currently at 120 per 100 000. However, the DoH would be content only when it stood at 0, as one death was one too many. There were mother to child clinics in each district which were equipped with paediatricians, gynaecologists and other specialists. These specialists travelled to the different districts and were provided transport by the province to ensure that they reached women who were at risk, and transferred their skills to the health professional at the local district clinics. Maternal mortality had become a key indicator for the provincial DoH. In the event of a death during childbirth, the nursing manager, the CEO of the hospital, the gynaecologist and anaesthesiologist had to explain the cause of death to the MEC, and whether it could have been prevented.

Non-medical doctors with no background in health or pharmaceutical services should not head divisions which dealt with these topics. People had been wrongly appointed because they have a PhD which was not in the field of health.

Many of the infrastructural issues at the Knobel Hospital which had been raised by the Committee required long term interventions. The hospital had one boiler, which was under constant repair, and the DoH aimed to purchase a new boiler at the beginning of 2018/2019 financial year. The medical equipment which doctors had spoken to Committee Members about during the oversight visit, such as the anaesthetic machine, had been ordered.

She said that the DoH had won its court case against the “Prophet of Doom,” as it had been scientifically proven that the Doom spray was absolved by the skin and had dire effects on people. The province would take stern measures against individuals who encouraged people to eat snakes and spray Doom, as it was a serious health concern.

Ms Mlangeni replied that Mpumalanga had felt the impact of the Committee's oversight visit, as the province had developed short, medium and long term interventions to address issues raised by its Members. During her presentation, she had mentioned some of the “quick wins” carried out at Matikwane, and people had recognised these improvements as good work done so far. The positive impact included better communication within hospital management, the painting of buildings and the installation of geysers. The province would continue to monitor these improvements and report back to the Committee.

The bulk of the province’s maintenance budget went to water, because the Bushbuckridge region had a water issue. Despite the challenge, the province was determined to supply the hospitals with constant water

The province took EMS seriously and had conducted a thorough analysis of its EMS service and compared it with other provinces. In its analysis, it had considered the number of staff and vehicles needed. Mpumalanga had learnt that other provinces charged for EMS services at government events, and the province may also enforce this in the future.

Mpulamgana was not proud about its staff equity ratio, but the employment moratorium may not improve the situation. The departments of Health and Education were exempted from the moratorium, and they aimed to recruit employees who were women and people with disabilities.

She would follow up about the Casteel Thusong Centre not having a fan.

She said that the first quick assessment had been focused on understanding the infrastructural challenges faced by hospitals and clinics, and had assisted the Mpumalanga DoH to develop a turnaround strategy. The second quick assessment had looked at whether all the issues presented in the first assessment had been addressed, and included new gaps and challenges faced by the health facilities. The third assessment aimed to address the critical issues identified in the previous quick assessments, and finalise the work of the current administration. A clear baseline had been established in 2012, while in 2016 a progress report had been written.

She apologised for the Mpumalanga officials’ behaviour during the Committee's oversight visit. She added that the Director General had personally intervened in the matter and had addressed some of the issues raised by Committee Members.

The Chairperson corrected Ms Mlangeni, and said that the Justicia Clinic did not have a fan. He asked her to give a written response on this matter, as Mr Khosa had raised the problem with staff at the Clinic.

He requested that both provinces give detailed written responses to Committee. The intention of Committee oversight visits was to visit one centre, but the provinces and departments must look at other centres and ensure that these centres gave the best service delivery. All provinces should email their update reports to Committee members.

The meeting was adjourned.