Deputy Chairperson, the Select Committee on Women, Children and People with Disabilities undertook an oversight visit to the Eastern Cape and KwaZulu-Natal provinces from 27 to 29 July 2010, in terms of the strategic priorities of the NCOP. The visit relates not only to the strategic priorities of the NCOP but also to the five-year strategic priorities of the committee, in terms of its priority of survival and development. It also had a basis in Millennium Development Goal 4, which relates to the reduction of child mortality rates of children under five.
The aim of the oversight visit in the Eastern Cape was to investigate the high rate of infant and maternal mortality in the province, the high number of youth deaths attributed to initiation and the interventions of the provincial department in this regard, and the interventions of the Eastern Cape provincial department of health.
In KwaZulu-Natal, the aim was to assess the implementation of measures to curb mother-to-child transmission of HIV and Aids in the province, to investigate infant mortality rates in the province and to conduct site visits to voluntary testing centres.
The Eastern Cape, particularly in rural areas, faces difficulty in attracting qualified doctors and nurses and has a chronic shortage of doctors and nurses. Some district hospitals may have equipment for intensive care, but do not have the nurses to staff it. Also, hospitals lack X-ray machines, foetal monitors, equipment to monitor the progress of labour, and incubators, to mention just a few. This equipment is essential for the medical personnel to perform their duties.
These issues present a major challenge and are mainly due to the poor referral system between hospitals. The challenge is exacerbated by an insufficient number of ambulances, which results in patients who have been stabilised and are able to return to local hospitals or clinics being forced to remain at the district and provincial hospitals longer than necessary. This increases the risk of infection between mothers who have just given birth and also to high-risk infants who have been reduced to sharing incubators due to overcrowding.
Another challenge that was highlighted was the vastness of the province and the long distances between referring hospitals, particularly district and provincial hospitals that are able to provide the appropriate level of care to high-risk patients.
Though the department presented the 2009-10 infant and mortality statistics to the committee, it refused to release data to the committee when further requested.
The department indicated that the high number of youth deaths as a result of initiation was a major problem in the province and their involvement came once the youth were admitted to hospital. While the department does not have an active strategy to deal with this issue, it has been in consultation with the Department of Co-operative Governance and Traditional Affairs to address it. Initiation needs to be more actively managed within communities and needs to be a collaborative effort between the department of health in regard to education and the Department of Co-operative Governance and Traditional Affairs and communities.
The department also needs to play a more active role, particularly in regard to education of the youth about family planning, the prevention of HIV and Aids, and sex education.
Further support in the communities, by way of training for women, can assist with various aspects of prenatal and antenatal care to pregnant mothers.
The purpose of the oversight visit to the Nelson Mandela Academic Hospital was to conduct a site visit to the facility to investigate their maternal and antenatal wards.
During a brief meeting with the management of Nelson Mandela Academic Hospital in Mthatha, overcrowding, poor referral systems, excessive waiting periods for transfers to local clinics or hospitals, an insufficient number of doctors, which places great pressure on hospitals that provide specialised high-risk care, and a lack of integrated development planning were identified.
The committee observed the following: an insufficient number of incubators for preterm babies, resulting in babies, having to share incubators, even though this is not in accordance with health regulations; large waiting rooms of postdelivery patients waiting to be taken to the local hospital or clinic; and a high level of hygiene maintained within the hospital facility.
The St Barnabas Hospital services 17 local clinics and it is often overcrowded, due to its central location near a major main road. The key challenge is also that of a chronic shortage of doctors, an urgent need for government intervention in respect of integration planning, and more incentives for doctors to work in rural areas. I wish I could repeat that. Furthermore, the hospital has a shortage of medicines and funding.
The vastness of the province is one of the underlying contributing factors to the high infant and maternal mortality rate in the province. The hospital is unable to provide a 24-hour service in key areas like radiography due to the limited number of radiographers in the province.
The Ngangelizwe Community Health Centre currently falls under the municipality and was in the process of being transferred to the Eastern Cape provincial department of health through a process of provincialisation, which forms part of the urban renewal programme.
The purpose of the meeting with the KwaZulu-Natal department of health was to assess the implementation, and the progress made in respect of the province's implementation of the Community Child Survival Campaign and Programme for the Prevention of Mother-to-Child Transmission of HIV/Aids.
The majority of KwaZulu-Natal's population are children and youth, and its health programme therefore has a strong focus on those groups. A study noted that the majority of children under the age of five years who die do not pass away in hospitals and clinics, but within communities. A provincial study conducted in 2008 determined that in respect of the deaths of children younger than five in the province, malnutrition was the underlying cause.
The department initiated preventive measures that sought to address issues of child survival within communities. The Prevention of Mother-to-Child Transmission of HIV/Aids Programme of the department is the flagship programme of the Kwazulu-Natal Provincial department of health and is aligned with the Millennium Development Goals. The province has 20 hospitals that provide specialised care to HIV-positive mothers in labour and a further 67 clinics that provide prevention of mother-to-child transmission. At present the department is able to provide antiretrovirals to 94% of babies of HIV-positive mothers. However, in respect of the implementation of this programme, the biggest challenge the provincial department has is funding. The following are key issues to be considered, as observed by the committee: lack of ambulances and an insufficient number of emergency medical personnel; poor management of patients in regard to referrals; insufficient number of doctors and nurses in the province; shortage of medicines and other essential medical equipment; overcrowding in hospitals; and an insufficient amount of accommodation for doctors.
Specific challenges for the Eastern Cape included illegal abortions, lack of incubators and oxygen tanks in hospitals and ambulances, no X-ray facilities after hours, and a need for radiography specialists and specialised scrub nurses.
The select committee noted the manner in which the Eastern Cape and Kwazulu- Natal departments of health have organised themselves to work towards implementing policy directives and programmes in improving the lives of women and children. The committee has furthermore observed the challenges faced by these institutions on the ground, particularly in regard to capacity, infrastructure and resources, as well as the negative impact that these have had on service delivery. The committee is now in a better position to understand these challenges after conducting site visits and observing first-hand the dynamics prevalent in all the facilities visited.
Debate concluded. Question put: That the Report be adopted.
IN FAVOUR: Eastern Cape, Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga, Northern Cape, North West, Western Cape.
Report accordingly adopted in accordance with section 65 of the Constitution.