1. Staff shortages were indicated in all health facilities visited. Health care workers are overburdened which further lead to long waiting times. 2. There is an indication of a growing population in some of the districts, this presents a challenge in terms of bed allocation in most facilities, which seems not to be meeting the growing population (for example JST hospital had 396 beds which were reduced by 60). 3. The budget allocated for the institutions is not enough which leads to budget influencing their plans and not the other way around. 4. Official transport is a major challenge as officials have to use their own personal cars for official duty. 5. Space shortages was identified which contributes to overcrowding wards. This was more apparent in ward 9 in Mafikeng Hospital and Boitekong Community Health Centre. 6. There is a lack of laundry services within some facilities and have to travel more than 200 km to get their linen laundered. 7. In some facilities there was underutilisation of space. 8. Severe shortages of linen were identified in most institutions visited. 9. Security concerns were identified in some of the health facilities. 10. Some facilities reported higher maternal mortality rates (Moses Kotane) and perinatal deaths (Lehurutshe Hospital). 11. There were equipment shortages in some health facilities. For example, in Moses Kotane Hospital, a mammogram machine was taken to JST Hospital and they were never given anything to replace it which makes it difficult for the hospital to screen their patients. 12. Equipment plans are not updated. At Mafikeng Hospital old ventilators are being used which were bought in 1997 and only three are functioning. 13. An X-ray machine was not properly fitted at Moses Kotane Hospital and was never used. The hospital is utilising a chest X-Ray which is a problem as patients have to stand even if they are not able to stand. 14. Poor infrastructure maintenance was identified in some facilities. 15. The issue of high teenage pregnancy was found to be a serious concern, together with a high number of requests for termination of pregnancy. 16. Wheelchair ramps were lacking in one of the facilities visited (Lehurutshe Hospital complex). 17. The delegation was also concerned that there is no health tourism, particularly around the Sun City area. 18. The absence of a tertiary hospital in the province presents a challenge as patients who require tertiary care have to be transported to other provinces. 6. Achievements and innovations