On referral system the Acting CEO noted that the health system within the Mpumalanga Province began at the Primary Health Care level where the referral system begins. Patients within the community start at a local clinic as the first point of entry and if the need of a patient surpasses what the clinic can offer, they are then referred to a district hospital. The next level of referral from a district is a tertiary hospital. Witbank does not have a full package for a tertiary hospital and it is for that reason that the province is having a Memorandum of Agreement with the Gauteng Provincial Department of Health for services that cannot be provided such as oncology, urology and neuro-surgical services.