The Select Committees on Health and Social Services, and Education, Technology, Sports, Arts and Culture have visited the Garden Route District Municipality to assess progress made on commitments made by various government departments during the National Council of Provinces’ (NCOP’s) Taking Parliament to the People programme, which was held in Oudshoorn in 2015.

The Garden Route District Municipality incorporates Bitou, George, Hossequa, Kannaland, Knysna, Mossel Bay and Oudtshoorn municipalities. The visit takes place in the context of the NCOP’s Oversight Week programme. Before the commencement of the programme, the departments and local entities presented progress reports on service delivery regarding the commitments they made in 2015.

The first service delivery site that was visited by the committees was Kannaland Municipality’s Carlitzdorp Clinic. According to Ms Maurencia Gillion, who is the Chairperson of the Select Committee on Health and Social Services, the visit was prioritised because the medical infrastructure in the Southern Cape forms part of the National Health Insurance (NHI) pilot projects.

The committees went to this clinic to assess the district’s readiness for the implementation of the NHI. Ms Gillion said: “Part of our presence in this district is to determine its readiness to launch the NHI as we know the Southern Cape has been chosen as one of the districts for the NHI pilot projects. This visit will in general help to determine the region’s readiness, highlight existing gaps that need to be dealt with to ensure that they won’t affect the effective and efficient roll-out of the NHI in future.”

Staffing at the clinic, especially the absence of adequate doctors, is a persistent problem which was identified in 2015 by the NCOP. Dr Terence Marshall, who is the Deputy Director, Referral Support Services in the Garden Route District, told the committees that staff shortage is a challenge not only affecting the Garden Route District, but all rural clinics across the country. “The trend is that most doctors prefer working in cities than in rural areas,” he said.

On hearing about the staffing concerns, Ms Gillion asked: “What is the national nurse-patients ratio to ensure that national norms and standards are maintained?” Dr Marshall said in response that it is 35-40 patients per nurse. But this ration, according to Dr Marshall, gets tested when nurses have to take leave. “This often leaves us vulnerable. Often we find it impossible to function. What is most challenging is that our annual budgetary considerations are not aligned to these challenges. As a result, we are forced to work with what we have,” he added.

Ms Gillion further asked about the readiness of the healthcare system of the district in rolling out the NHI. “Is the health system of this area ready for an NHI roll-out. Does it have enough doctors as envisaged in the NHI.”

The Chief Director of the District National Health System on Primary Health, Mr Ramphelane Morewane, said: “The pool of doctors to service the needs of the NHI will remain a challenge. The system seeks to encourage service providers who are out of the public health system to render their services. But currently the purchasing pool is limited and that makes it expensive to use doctors with specialised skills, and the purchasing cap envisaged in the NHI will not alleviate this predicament.”

A member of the delegation, Mr Mbulelo Bara, pressed on: “How do you balance the human resources component and the medical demands that the clinics in rural areas are faced with? Because we need consummate human resources to meet the objectives of the NHI. How do we balance all these factors to ensure that the NHI objectives are achieved?”

Mr Morewane said the national norms and standards are that “we work and we allocate staff per capita. Yes, there are challenges to that, but it is what we currently work with. Ideally, the primary healthcare system is nurse-driven. We must ensure that we convince our people that not every patient needs to be seen by a doctor. Whether a patient needs to be seen by a doctor or not is something that must be determined by a nurse. But generally speaking, many patients want to be seen by a doctor even if there is no need for that”.

The committees heard that the ongoing problem faced by the health sector in this area is substance abuse. Ms Gillion wanted to know how the social services are dealing with this matter. “I am asking this because there is seemingly no collaborative effort from the social cluster to deal with this matter.”

The Social Work Manager for Oudshoorn and Kannaland, Mr Dennis Nghonyama, told the committees that there is a joint planning initiative of all social services clusters that deal with substance abuse. He said: “We review this collaborative effort quarterly to revive its effectiveness. But much of the work is carried by the local drug committee, whose functionality needs to be looked at closely to ensure that it achieves what is set to achieve.”

What was also of concern to Ms Gillion was the lack of clinic committee. “This would create huge problems because the clinic would not have a channel to explain to the community the challenges it is faced with. Some of which are beyond the clinic’s administration’s means. This could, in a long run, help to normalise the clinic’s relationship with the communities it serves.” The delegation was relieved to hear that the election of the local clinic committee was underway.

The committees also visited the Help Mekaar Bejaarde Klub. This old age club was established in 2005, it has more than 35 members who make hand-made hand bags from recycled material to sustain their cooperative. Ms Gillion decried the condition of the structure in which they operate.

She asked the local municipality if it can’t assist in ensuring that “the club is located in a more resourceful place than the dilapidated church they operate in. The Administrator of Kannaland Municipality, Mr Wessel Rabbets, committed himself that they will assist the club where possible to alleviate its plight because the answer to employment in these areas lies in copperatives. “We propose a synergy between all sphered of government. Currently they work in silos.”

In his view, there is a need to relook at how Integrated Development Plans are conducted. “We need to listen to people more; what they need and factor that in the municipal budgetary and annual plans.”

The last visit yesterday was at the Carlitzdorp Combined School in Kannaland. The committees were surprised that the school had no Grade 12 maths tuition this year. When the delegation asked the School Principal, Mr Andrew Davids, why. They could not get a satisfactory answer from him because he inherited this and was also surprised by it when he took up the post in April this year.

But he reassured the delegation that he is in a process of reviving maths tuition next year. He said: “Given the fact that this is an agricultural focus school, I can reassure you that there will be Grade 12 maths tuition next year. We can’t allow such a situation to be prolonged, for it would deprive our students an opportunity to enrol at tertiary institutions.”

Ms Gillion decried the current status quo and the fact that most of the schools in the district do not take advantage of Petro SA Maths School of Excellence. “Petro SA has a made a pledge to take 80% of students in its academy from the Garden Route District. But seemingly schools in this district do not take advantage of that,” said Ms Gillion.

The district cannot afford not to take advantage of that. “We challenge you to go to Petro SA to ensure that you enrol your students, and you ask them to help you to have a much more solid maths foundation.”

The Chairperson of the Select Committee on Education, Technology, Sports, Arts and Culture, Mr Elleck Nchabeleng, said the district must take cue from the province’s resolve to produce students that will partake in the new economy that is driven by the Fourth Industrial Revolution.

“The school must cultivate students for future jobs. Your active and competitive agricultural tuition puts you in good stead for you to contribute in producing students that would lead the technological advancement in this field,” said Mr Nchabeleng.

He added: “As we can see that technological equipment is not only replacing humans, but is alleviating the work load and increasing production. Being an agricultural focuse school, you must ensure that you take advantage of these future developments.”

By Abel Mputing
23 October 2019