Disability issues raised in public hearings: Departments of Justice, Health & Transport responses

Meeting report

Responses by departments to issues raised at the public hearings on the implementation of the United Nations Convention on the Rights of Persons with Disabilities
Department of Justice and Constitutional Development briefing
Ms Nonkululeko Sindane, Director General, Department of Justice and Constitutional Development (DoJ), briefly outlined the rights of disabled persons as contained in the Constitution of South Africa, and the UN Convention on the Rights of Persons with Disability (the Convention). She noted that the National Register for Sex Offenders under the Criminal Law Amendment (Sexual Offences and Related Matters) Act, 2007 was in place. She also noted that the Promotion of Equality and Prevention of Unfair Discrimination Act, 2000 had designated all courts as Equality Courts, and the Children’s Act of  2005, had designated all Magistrate’s Courts as Children’s Courts. Disabled children were accepted as being more vulnerable than non-disabled children.

The Justice, Crime Prevention and Security Cluster emphasised the importance of a collaborative approach between the Departments of Social Development, Health, Education, and Women, Children and People with Disabilities (WCPD), the South African Police Service (SAPS) and the National Prosecuting Authority (NPA), amongst others. She also thought it important that they report internationally. She noted the existence of the Consultative Forum on People with Disabilities, chaired by WCPD, the Intersectoral Steering Committee on Sexual Offences, chaired by the DoJ. The first draft of a National Policy Framework on Sexual Offences had been submitted to Parliament, which requested a specific charter for people living with disabilities. A National Child Care and Protection Forum was chaired by the Department of Social Development (DSD), and the National Children’s Act Working Group was chaired by the DoJ.

The DoJ had plans to increase accessibility in existing court buildings which were not sensitive to the needs of disabled persons and all new court buildings built since 2009 were designed to be fully sensitive and responsive. In relation to interpreters, she explained that there was a limited number of sign-language interpreters available, and DoJ had asked DeafSA to help with recruitment. The interpreters received training from the Justice College, and could then be used also for matters other than sign language interpretation. There was a plan to recruit unemployed matriculants, to be trained in the financial year of 2013/2014. School-going learners could, in the meantime, train in certain courts which operated over weekends. The identification of eligible candidates was already under way.

Ms Sindane explained that in certain cases, intermediaries were responsible for representing the interests of a child and that there were plans for training intermediaries through Justice College.

She explained that under the justice system, the presumption of innocence applied to all accused persons, including those who had harmed a person who was disabled. There were policing and other systems in place to protect any victims from accused persons who had been granted bail and these should obviously apply to disabled victims as well. Information should be collected in future on accused persons who were granted bail, although unfortunately this had not been done up to now, although intermediaries inside various communities did keep the DoJ informed. She stressed again the importance of intersectoral communication.

Ms Sindane noted that the length of time taken to finalise a case would depend on the whole value-chain of the JCPS Cluster. It was the DoJ’s responsibility to ensure that the file for prosecuting a case was ready. She raised the issue of intersectoral cooperation again and said that if the prosecutor became involved only at a late stage, and could only then point to something that was missed, this resulted in wastage of time. Priority was given to cases involving vulnerable witnesses (which included witnesses with disabilities) by the JCPS Cluster, as well as the judiciary.

The DoJ prioritised cases involving maintenance for children with disabilities, who were often being cared for by their mothers or grandmothers, and the services of the Master of the High Court, relating to deceased persons’ estates. Both of these categories of cases involved those who were not in conflict with the law and maintenance cases, in particular, affected children who were classed as most vulnerable. The DoJ’s Service Charter and Service Delivery Standards focused specifically on the above categories. Ms Sindane then explained the complaints procedure (see attached presentation), and noted that she, the Deputy Minister and the Office of the Presidency would make unannounced visits to assess the situation before meeting with management on these complaints. Area and regional managers were responsible for ensuring that complainants were treated with respect, and their time was not wasted.

DoJ would pass on information to other organisations, where applicable, but it could not, for instance, give instructions to the judiciary on how a case should be handled, although the judiciary was receptive to getting pertinent information.

Ms Sindane noted that although the DoJ had specific focus areas, it was not keeping any records on a specific focus on disabled persons.

In terms of its internal staffing, 1.09% of the DoJ’s staff were disabled, and the Department was trying to increase this by contacting organisations who dealt with disabled people. All advertisements for vacancies did state that disabled persons were encouraged to apply, but responses, especially for senior posts, were not forthcoming from the disabled. She said that awareness campaigns addressing attitudes to disabilities might encourage more applications.

Ms Sindane tabled brochures that the DoJ had prepared on maintenance, and maintenance applications, on domestic violence, a manual on the  Child Justice Act, and “FAQ” booklet on maintenance. Two information booklets had been published in Braille on the rights of children under the Children’s Act, 2005 and the Domestic Violence Act, 1998. A third on how to claim maintenance was being finalised. R3 million had been set aside for the development of Braille booklets.

Discussion
Ms H Lamoela (DA) asked how the DoJ attended to distribution of brochures. She enquired how many names were presently on the Register for Sex Offenders.

The Chairperson asked whether the Register for Sex Offenders was understood by the relevant parties.

Ms Lamoela asked if there was a timeframe to make the courts disabled friendly and for installing lifts. She pointed out that most of these older buildings were in rural areas. She questioned if any doctors, magistrates and investigating officers knew sign language. She wanted details of how the DoJ advertised its senior positions. She finally asked the DoJ to enumerate its challenges.

Ms M Nxumalo (ANC) asked what specific initiatives were in place for the disabled, whether budgets had been earmarked for them, and what the costs were.

Ms D Robinson (DA), Member of Portfolio Committee on Health, asked how information was made available, and said that she had been hoping to receive more statistics.

Ms P Kopane (DA), Member of Portfolio Committee on Health, asked whether and how the training given to interpreters was accredited, and wondered if the DoJ had approached any teaching institutions to recruit. She asked if the disabled people within the DoJ itself had been asked to complete exit reports when they had resigned.

Ms Robinson picked up on this point, and agreed it was important. At the Department of Police, those with disabilities who were employed had complained that they were assigned to “dead-end jobs”, were not challenged intellectually, and were excluded from recreational functions. If they complained, they ended up being further victimised. She asked how seriously these issues were taken by the DoJ.

Ms S Paulse (ID) asked where the documents mentioned could be accessed.

Mr D Kekana (ANC) remarked that the partnerships between the DoJ and other entities were poor, particularly the Department of Basic Education. He said the employment figure of 1.09% was too low. He also asked for further comment on the granting of bail, and on withdrawals of cases, noting that in terms of the Criminal Procedure Act of 1977, this was the responsibility of the judicial officer.

Ms Sindane noted that in some cases, it was true that victims would withdraw their complaints, leading to non-prosecution. Particularly in domestic violence matters, the victim was often dependent on the accused, and there was also often pressure from the victim’s community to withdraw a case. Sometimes investigators could not find enough evidence and a case had to be withdrawn. She said there was a need to engage with people on this issue, perhaps via the radio and other media, to encourage victims not to withdraw cases for the wrong reasons.

Ms Sindane responded to questions on the manuals by stating that they were distributed to schools, NGOs, government departments, on the internet and in courts. However, she conceded that this was inadequate, and that rural mobilisation needed to happen. There were cluster imbizos geared towards this, and a lot of information was disseminated on Human Rights Day every year. She said that the DoJ would make use of its partnerships with constituency offices to get closer to those on the ground.

Ms Sindane responded that there were currently 2 900 names noted on the Register of Sexual Offenders, and this number was growing. However, there was no breakdown as to how many offenders had acted against the disabled or the mentally disabled. Whilst DoJ did collect some statistics, she conceded that the functionality of the statistics could and should be enhanced.
 
Ms Sindane could not answer for how many medical personnel knew sign language but was sure that most investigating officers did not know sign language. There was a possibility of training them, but for the foreseeable future the JCPS Cluster departments would still be reliant on interpreters. The accreditation of training was undertaken by the Department of Social Development and the courses on which employees were sent were accredited by the South African Qualifications Authority (SAQA).

In regard to internal vacancies, she noted that the DoJ advertised its positions in newspapers and on the radio and also had partnerships with certain universities through whom advertisements were also placed. This was a major challenge that the DoJ faced. Word of mouth was used, particularly where a vacancy required particular skills. The DoJ had partnerships with tertiary institutions, especially those concerned with women, children and persons with disabilities, as well as professional bodies like the South African Women Lawyers Association, who spread the DoJ’s message on their behalf. Ms Sindane noted the comment on the types of jobs that the disabled were given but said that she was not aware that this was a problem in DoJ, which had a particular strategy around promotion of employees. If any disabled people were not given promotions, this would be for reasons other than their  disabilities.

Ms Sindane repeated, in relation to the question on funding, that R3 million was earmarked for braille, and R10 million for court upgrades, but more funding was needed. The question on exit interviews would be answered by one of her colleagues.

In response to the comment about the relationships with the Department of Basic Education, Ms Sindane said that in relation to social development there were two intersectoral committees - one dealing with children and one dealing with sexual offences. Interaction was necessary, as the relevant ministers needed to sign off on all decisions. In regard to the comment on the Criminal Procedure Act, she noted that it was not appropriate to amend this Act at the moment. There had been amendments, for instance, dealing with powers of arrest. A far more comprehensive study would be needed, for instance including the numbers of times that offenders re-offended when granted bail, before any reasonable and meaningful amendments could be made.

The Chairperson requested that any outstanding responses be submitted in writing.

Department of Transport briefing
The Committee questioned the absence of the Director General of the Department of Transport, and the fact that no apology was tendered. They also expressed frustration at receiving the briefing document so late on Friday, and commented, after the presentation, that it was not the final version and did not align to the presentation.

Ms Khibi Manana, Chief Director, Department of Transport, explained that integrated public transport networks (IPTNs) integrated local rail, bus, minibus and metered taxi services. The Department of Transport (DoT) had prioritised Bus Rapid Transport (BRT) and Rapid Rail under IPTNs.

Passengers with special categories of need (PSCNs) would be provided for, as required by law. These were listed in the National Land Transport Act as people with disabilities, the aged, pregnant women, young children, and those who were limited in their movements by children. The DoT had identified additional categories of passengers who could not read or understand signage, female passengers, because of safety and security risks, and load-carrying passengers, such as cyclists.

The timeframe of “at least until 2025” was given for sustainable and universally accessible networks to be completed, because of the historical neglect of public transport.

PSCNs had to be accommodated in each step of the travel chain, from planning a trip, to reaching the pick-up point, getting into a vehicle, making the journey, getting out of the vehicle, moving on to final destination, and giving feedback on the trip. The UN Convention required that universal design and universal access be used to this end.

She outlined the five pillars of the strategy to guide the provision of accessible public transport systems, which were the creation of an enabling environment, continuous upgrading of existing services, provision of integrated rapid public transport networks (IRPTNs) and IPTNs, the roll-out of rural transport packages, and improvements for legacy projects.

The universal design access plan under the public transport infrastructure systems grant covered transport planning, the operational context, marketing and communications, customer care, the fare system, passenger information and way finding, infrastructure and vehicles. Access consultants would help in designing and evaluating transport systems, with particular attention given to PSCN requirements. Access auditors would oversee and advise on the integration of universal access in transport services. The public transport operations grant would provide supplementary funding.

Dr Enos Ngutshakse, General Manager, Passenger Rail Agency of South Africa, said that he would present the Universal Accessibility Presentation. He skipped over the first  two slides, which gave the background information, and noted that slide 3 dealt with the corridors, route and movement of buses.

A Committee Member interjected at this point to enquire if any hard copies of the presentation were available, and Dr Ngutshakse responded that there were none.

The Chairperson noted the Committee’s further concern and frustration.

The Committee, having debated the point, decided that DoT must return to present a complete briefing at another time, and must provide the Committee with all the relevant documents well ahead of time, as well as ensuring that further copies were available on the day.  The Committee further expected the Director General to be present.

The Chairperson excused the delegation from the DoT.

Department of Health briefing
Dr Yogan Pillay, Deputy Director General, Department of Health, apologised for the absence of the Director General, who was dealing with problems in Marikana, and this apology was accepted.

Dr Pillay said that he would focus on four central issues that were raised during the public hearings. Firstly, he tabled figures for the number of qualified practitioners registered with the Health Professions Council of South Africa, broken down into type. There was another reference specifically to psychologists, with a comparison of numbers across the provinces, and the number of rehabilitation personnel in the public health service, broken down into type and compared across provinces (see attached presentation for details). He highlighted the strong variance across the provinces in terms of health care practitioners.

Dr Pillay noted that specialised hospitals were limited in number, and speech, language and hearing services were the least readily available at primary level. He spoke about plans for the retention and expanded training of existing personnel. He highlighted the problem that most rehabilitation therapists were in the private sector. Primary health care (PHC) was being re-engineered, and rehabilitation would now be included and would also be integrated with programmes at policy planning and implementation levels, to ensure comprehensive care.

In terms of physical access at healthcare facilities, district hospitals had been shown to be least accessible but all requirements for accessibility would be adhered to at National Health Insurance (NHI) pilot sites. A survey would also be done to enable the Department of Health (DoH) to enhance the quality of service received.

Dr Pillay also stressed that the DoH acknowledged that rehabilitation extended beyond the health domain. It was necessary to have an intersectoral approach to comprehensive management. He listed the government departments, civil society and professional associations with whom the DoH collaborated on disability issues.

With regard to assistive devices, Dr Pillay mentioned that whilst there was improved technology for patients, it was often also more expensive. For instance, the newest hearing aids could cost up to R20 000. There was a need to consider specific needs in certain areas; for instance wheelchairs were needed for use in rural areas that could be used in multiple terrains, but these would certainly be more expensive.

Finally, Dr Pillay touched on the barriers experienced by persons with disabilities and their caregivers (see attached presentation). He outlined the expected increase in the number of posts within the DoH, and the expected increase in funding allocation for assistive devices. Dr Pillay added that prevention was also very important, and closed by setting out some specific challenges of personnel and funding.

Discussion
Ms Lamoela asked what happens when patients returned to their communities, and whether there were rehabilitation centres there. She noted that she favoured an integrated approach, including social workers and health clinics.

Ms Lamoela wondered if the high costs associated with caring for persons with disabilities could be curtailed if disabilities were identified earlier in babies.

Mr Kekana thanked Dr Pillay for the presentation, noting that he had been present during the public hearings. He wanted more details on the preventative measures that were a world-wide trend, asking if there was a specific campaign on this in South Africa.

Ms Robinson also commented on the improved care made possible by early detection. She asked which level of hospital was able to administer hearing tests at birth, and whether there were plans to expand the number of hospitals able to do this.

Ms Lamoela noted that there was a high prevalence of sexual abuse of disabled persons, and asked what the DoH’s approach to this was. She referred to a presentation made in February when DoH had been asked to comment on its commitment to addressing the inadequacy of services in general for disabled persons, and the lack of services at community level, and asked if there had been any developments on this.

Ms C Diemu (COPE) enquired as to the complaint mechanisms in place, and asked whether there was any earmarked funding.

Mr Kekana repeated Dr Pillay’s point on the distribution of therapists, remarking that urban communities were better off in this regard. He explained that therapy could help in curing or alleviating disabilities, and asked what programmes were in place in rural areas, given the smaller number of clinics there.

Ms Robinson asked about the possibility of recruiting out of teaching hospitals, to address the problem of insufficient staff, and also wanted to know what was being done about working conditions to retain existing staff. She commented that an integrated approach to persons with disabilities was working well, citing a recent conference relating to people with Down’s Syndrome.

Ms Nxumalo mentioned that no assistance was available in sign language at many clinics, and cited the example that a deaf mother’s boyfriend had given her child his name, against the mother’s wishes, because nobody could understand the mother’s instructions. She asked what measures were in place for providing healthcare information and materials to blind persons, especially in rural areas.

The Chairperson asked how close the DoH was to reaching its 2% target for employment of people with disabilities, what the greatest challenges were, and whether anything could be done about the high cost of assistive devices.

Dr Pillay started his responses by giving general comments that he believed would address some of the themes that the Committee had raised. Primary Healthcare was being re-engineered to try to get services to communities. A major focus of this would be prevention, and another focus was seeking to take the care to the patients, to address the difficulties that they often had in travelling to seek healthcare. Both of these issues would enable healthcare workers to attend to problems earlier.

He noted that the DoH attempted to cope with its challenges in three main ways. Firstly, it aimed to have an outreach team in each ward, comprising six healthcare workers, a health promoter and a health practitioner, as well as auxiliary team members, and these teams would be linked to community caregivers. He explained that there were many workers at present, but there was lack of coordination and linkage, and DoH was seeking to address that now. The DoH was in its second round of training the outreach teams. Secondly, DoH offered school mobile services, which his colleague would elaborate on shortly. This was set for launch in September 2012. Thirdly, teams of seven specialists were being made available to improve clinical quality, focusing on maternal and child health (and here, he stressed that prevention was an important element), HIV, TB, and non-communicable diseases. The DoH did not have a full team for each district, but the positions had been advertised, and 172 people were already employed nationwide to be part of these teams.

The problem of discrimination by healthcare workers was not confined to disabled patients, as many people complained of ill treatment, especially in terms of maternity care. On the other hand, there was also positive feedback on patients’ experiences from others, so there was a mixed bag of service delivery. The complaints system was quite broad, including the presidential hotline and the Minister of Health’s mobile phone, from which complaints would be directed downwards to the appropriate departments, as well as the more formal route of submitting a complaint in writing. An audit of 4200 health facilities had been completed, and the DoH was now aware of specific issues in each facility.

Prof Melvyn Freeman, Chief Director, DoH, expanded on the comments about early intervention. He said that people with disabilities had a number of possibilities open to them, and that early screening of all babies was the best way to ensure appropriate care. The problems with this were the expense involved and the lack of staff. The DoH was consulting with experts and recommendations would be coming out soon, which the DoH would share with this Committee. However, the DoH did not want to overload community health workers with disability and counselling interventions, thus rendering them unable to perform any tasks at all. The community health workers would, however, be required to include any persons with disabilities in their registers of families in their areas, so cases where disabled children were not presently known would hopefully be discovered in this process.

Prof Freeman said that raising awareness about disabilities must also be done through the medium of audio tapes and in Braille for the relevant groups of disabled persons.

Dr Nonhlanhla Dlamini, Chief Director: Child Health, DoH, spoke about the importance of the first 1 000 days of life: from conception until the age of two. She said all women should go for their first check as early as the time that they first missed their period, which would help in identifying high risk pregnancies. All babies should be checked at birth and home visits should be made during the first six days of life, and again at six weeks. This would help to spot, in particular, defects with vision, which were not immediately apparent or detectable earlier.

There had been school health services since 2003, but this had since been reviewed, and the DoH was now recruiting retired nurses who were still able to work. The ideal would be one team per school, but at present the DoH was prioritising under-resourced, rural schools, falling within Quintile 1. Because the teams could not see each learner separately, the plan was to target students according to their educational phases. In the foundation phase, the focus would be on hearing and vision disabilities, as well as psychosocial barriers to learning. In older age groups, the focus would move to mental and sexual health. The language used would be appropriate to the age group addressed. Mobile clinics would be fully equipped for optometry, dental health and PHC.

Ms Lamoela interjected to note that many poor students also attended the schools in the higher quintile groups and cautioned that they too needed to be targeted.

Ms Lamoela asked whether the nursing colleges that had been closed would be reopened.

Ms Sandliya Singh, Director, DoH, said that rehabilitation had not previously been included under PHC, and that community-based rehabilitation was now being rolled out.

Ms Singh also addressed the question on complaints procedures, by adding that part of the assessment of healthcare facilities included whether they had complaints boxes placed at strategic points, and whether there were clear instructions on how to use these. (The fact that some disabled persons had complained was a good sign that they were proving useful).

Ms Singh added to what had been said on equitable distribution, by explaining that therapists must do community service, and that it was up to the provinces to ensure that these posts were created in rural areas where help was needed most.

Dr Nathaniel Khaole, Director: Women and Maternal Health, DoH, said that DoH did not have a target figure for its employment equity, but the focus of his programme was on training for the prevention of disabilities and the medical genetics education programme. He spoke about the DoH’s partnership with the South African Inherited Disorders Association. He agreed that the number of nurses being trained was insufficient. However, nurses were being targeted for training to recognise problems caused by genetic problems which could lead to disabilities.

Ms Singh added that prevention of disabilities caused by alcohol and substance abuse was very important, especially because it was so easily preventable. She mentioned that having a child with foetal alcohol syndrome was in fact a crime.

Dr Khaole also addressed the re-opening of nursing colleges, and said that the current focus was on training midwives. DoH wanted expectant mothers to be made aware of the possibility of inherited diseases during antenatal clinic visits, but was also conscious of the fact that they should not be put off making the visits for fear of what they might discover.  

Dr Khaole also noted that DoH was in contact with the South African Sign Language Interpreting National Centre (SASLINC) for sign language training.

Dr Pillay informed the Committee that the disability employment figure within DoH was 1.4%, but that it was improving. DoH planned to encourage disabled persons to apply for advertised positions through civil society organisations and was also intending to address the perceptions of barriers for persons with disabilities, as well as working on awareness of the opportunities available.

Closing comments
The Chairperson said that she foresaw a return to the style of medicinal care from earlier years, and was particularly appreciative of the DoH initiative to take care to communities. She also agreed with the preventative approach, and thought fewer patients could be expected in the long run under this approach. She urged the DoH to work on awareness in particular.

The meeting was adjourned