Persistent to its resolution to assess the efficacy of healthcare facilities in the Free State province, the delegation of the National Council of Provinces (NCOP), whose oversight work this time is in Botshabelo, visited the Harry Gwala and Itumeleng Local Clinics.
There are striking similarities between the two. They both have no pharmacist and have to bear the brunt of servicing an extensive catchment area with minimal staff complement.
The only difference between the two is that the Harry Gwala Local Clinic has the state-of-the-art infrastructure, while its distant neighbour has infrastructure challenges to contend with.
Despite these challenges, these facilities continue to optimise the implementation of key priority programmes such HIV/Aids and TB testing. And the success rates presented to the delegation are quite impressive, especially at the Harry Gwala Local Clinic.
“On HIV/Aids testing we currently stand at 95%. The success rate for TB treatment is 89%. Our success can be attributed to the fact that if patients don’t come to the clinic for treatment, our Community Health Workers (CHWs) go to their homes to administer their treatments,” said the Operational Manager of Harry Gwala Local Clinic, Ms Kesebeloang Miya.
Speaking of which, a number of Community Health Workers were on hand to state their grievances to the delegation. Stating, among other things, that they are not often paid on time and in other months they do not get paid their stipends at all – and would not be provided with any form explanation as to why they have not been paid. The problem, according to them, is that they have are not paid directly by the Provincial Department of Health, but are outsourced to non-governmental organisations (NGOs).
“We are working for the Department of Health but we get paid by NGOs contracted to it. We have since defaulted on our policies and we cannot send our kids to school because in other months we don’t get paid. And we have been volunteering for years without any prospects of permanent employment,” said one of the CHWs, Ms Miemie Molise.
The Deputy Chairperson of the NCOP, Mr Raseriti Tau, decried the treatment meted to the CHWs. He asked the representative of the Provincial Health Department and the provincial Treasury to explain what is the service level agreement between these respective departments with both the CHWs and the NGOs that they are contracted to.
“We cannot continue like this. Something needs to be done to solve this problem because the CHWs play a critical role in our country’s Primary Health Care system. But in addition to that, some of them are bread winner and this is their only source of employment, they cannot go on months on end without being paid their stipends.”
All CHWs are contracted to the NGOs that is a national practice, our province is not an exception, said the Chief Director of Human Resources in the Provincial Health Department, Mr Lucky Kamolane. “What has been raised by CHWs is a national problem. As we speak, there is a finalisation of the policy regarding the CHWs across the country. That is being discussed as we speak.”
The Chief Director of Sustainable Resource Management in the provincial Treasury, Mr Pakiso Lebone, said there are challenges regarding the CHWs. One of which is their funding model. “As we speak we don’t know how to absorb them permanently within the Provincial Health Department. And from which budget stream will their stipends come. This is a case because there is yet no clarity on how they will be factored in the health fiscal frame work.”
There is also no uniformity as to how much they should be paid, he said. “There was a national agreement that we should pay them R3 500 a month. Depending on the province, some are paid more or less than that stipulated amount.”
He also added that the non-payment of CHWs by the NGOs they are contracted to was due to their failure to meet certain objectives, as a result the department withheld payment.
But what also dominated the proceedings of this oversight visit was the high rate of vacant positions in various health facilities in this district.
“We have heard throughout these presentations about the high rate of vacant positions at senior levels. Most senior personnel of these health facilities have been acting for more than four years. Why so, we want to get clarity from the department on that, said the Whip of the Free State delegation in the NCOP, Ms Moji Moshodi.
According to Mr Lebone, the high rate of vacant senior posts in these facilities is a result of the compensation moratorium that seeks to cut the public sector’s wage bill to unlock funding for other priorities. “We have written letters to various health facilities requesting them to give us their human resources plans that articulate the need for the filling of critical posts. This process, as we speak, is ongoing.”
In plenary we had a discussion with your MEC, there is an acknowledgement that there is a serious problem in this province – and as a result the Provincial Health Department was put under administration. Would Treasury explain what is its role in unlocking resources to ensure that there is quality healthcare service in this district, enquired Mr Tau. “We had a pre-visit here and there was a sense was created that the Provincial Health Department was under administration. What is the role of Treasury to unlock resources to improve the situation in this regard? Many nurses try to do their best with the little they have. I think more can be done to assist their endeavours. Can the provincial Treasury also tell us why they are on board to help this department?”
We are still under administration, but we are glad to announce that we now have an unqualified audit after nine years, said Mr Kamolane. “That will enable the Treasury to look at us differently. And this serves to confirm that fact that we are now on our feet and prepared to assume our responsibilities.”
Part of our strategy was to look at the financial management of the department, which often runs out of cash. That is why we put it under administration. We released a diagnostic report which identified problems related to the accrual of goods and expenditure on human resources, said the representative of the Provincial Treasury, “For instance, we brought down expenditure on overtime. And we realigned governance issues such as policies and standard operational procedures. Now that the department is stable, we will prepare a memo and allow it to function on its own. But there are areas that still need further intervention. However, we are quite happy with the progress it has made thus far.”
The Deputy Chairperson of the NCOP said he was raising all these matters because if the department fails to deliver on its mandate, the NCOP would have failed to conduct its constitutional mandate and would have failed the people of this district. “If these facilities don’t provide quality services to the people, I won’t blame their management, we are to blame. As the NCOP we should ensure that the department does what it is supposed to do to improve its service delivery commitments.”
After this event, we will have follow-up visits to see if the department has delivered on its commitments to ensure that we hold it accountable, she said.
By Abel Mputing
23 August 2017
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