By
Hon. NJ Nkwanyana, IFP MPL
KZN Legislature, 27 July 2023
Hon. Chairperson,
Hon. Speaker,
Hon. Members,
The 2022 Health Institutions’ Functionality Monitoring Programme was held in the Amajuba District from 5 – 6 October 2022. In terms of the 2022 Health Functionality Programme, there are a total of 59 primary healthcare facilities in the province. The purpose of the study is to investigate the functionality of primary healthcare facilities, with a special focus on the performance of outreach teams, infrastructure, human resources, adequate medicine and supplies, good administrative processes and sufficient bulk supplies, that use applicable clinical policies, protocols and guidelines, as well as NHI programmes.
Next time, this Programme must also include the Phoenix and Fort Napier Mortuaries, as they have been in news for the wrong reasons, due to the Department’s failure to attend to poor working conditions.
KZN’s healthcare system has been battling various issues – including the low number of institutions and less-than-adequate human resources – for quite some time. There is a need to make people and processes in the healthcare sector more accountable; for that to happen, greater operational transparency is urgently needed.
The IFP is of the view that our healthcare system needs a complete overhaul if we are serious about delivering good health care to our people. We need substantial change, not just tinkering around the edges and fooling ourselves that we are making progress. The review should detail the radical reforms that will be required to move us from where we are now. The reforms that I speak about must be inclusive of infrastructure, personnel and material supply reforms.
The Report revealed that more still needs to be done to address the challenges that are plaguing our healthcare facilities. Some healthcare facilities are faced with staff shortages. It is an undisputed fact that in KZN, a staggering 81.9% of households rely on the public health service. In addition, the KZN Department of Health is experiencing a shortage of medical staff in relation to the increasing size of the population.
The 2022/23 APP shows that the number of professional nurses per the population of 100 000 is 152.5. This proportion represents 17 816 professional nurses and medical practitioners per 100 000 people, servicing a population of 11.583 million. The total population in KZN is serviced by an average of 3 234 medical doctors. This number represents approximately 27.4% of the required proportion of required health professionals. According to the Department, there is also an estimated funding gap to fill critical vacant posts amounting to R2.5 billion (7 004 per latest HR Plan).
An example of this was seen at Rosary Clinic, where there are not enough nurses to span the 24-hour operation format. Currently, there is a shortage of four Clinical Nurse Practitioners (CNPs) and one Enrolled Nurse (ENs). This again leads to dissatisfaction and fatigue among the nurses currently serving at the facility. In eThekwini, some units have over 25% vacancy rate. The other issues of great concern are the lack of Operational Managers (OMs) in areas such as uGu and Harry Gwala Districts. The filling of vacant posts must be addressed and expedited.
As more people use public healthcare facilities, it is only sensible that the health system will have to be better equipped and will need more capacity to serve more people. Unfortunately, the investment in health infrastructure does not reflect this – bringing into question whether quality healthcare for all will be achieved in our lifetime.
It is worth noting that during the 2023/2024 financial year, there are allocations made available that are directed to infrastructure, as the Department plans to spend R6.8 billion over the medium-term expenditure framework on infrastructure. Amajuba District reported that the Department last commissioned a new facility in 2013. As such, the growth in population vis-à-vis the number of facilities built paints an uneven picture.
This means that the Department is unable to match the growth of the population, thus posing an imminent challenge of space. Also, in Zululand three clinics were reported to have inadequate infrastructure. These are Glucksdat, Siyakhathala, and Nhlungwane Clinics. More clinics must be built in our communities and dilapidated buildings must be fixed. Overcrowding must also be addressed.
We are concerned about the failure to address service delivery issues when they are reported to the relevant authorities, as has been the case with Emadlangeni and Dannhauser sub-districts, where the unfavourable terrain prevents the mobile clinic units from accessing some areas due to poor road infrastructure. Further, the issue of budget cuts is of great concern, as uMzinyathi District has suffered a R16 million budget cut for the 2022/23 financial year. This has had a huge negative impact on the budget of the Primary Healthcare facilities. We urge the MEC to address the issue of budget cuts.
It is also of great concern that some districts are faced with shortage of ambulances, such as Zululand District. These factors delay response times in emergencies and affect daily operations. Nakuba sazi ukuthi isibalo sama-ambulensi sizokwenyuswa azosuka ku-179 aye ku-200 ngo-31 March 2024 kodwa lesibalo asanele ngoba abantu abaningi ikakhulukazi emakhaya basalinda umlibe i-ambulensi ingafiki. The IFP calls upon the Department to ensure that ambulance response times are quick and efficient.
In addition, the issue of water and electricity supply must also be addressed.
The waiting time in clinics is a major concern. The objective must be to shorten the waiting time at points of entry, so that patients can receive treatment as quickly as possible. People have to wait for hours just to get medical attention and many people who are admitted to these hospitals are neglected and end up in a worse condition than when they arrived.
The situation in rural areas is even worse, as people have to travel for miles to receive medical attention from clinics and this costs them in terms of time and money, which they cannot afford. Health services must be quickly delivered so that people can move on to other commitments. We should not allow poor service delivery to be the acceptable benchmark in KZN.
The IFP believes that a strong healthcare system can only be built with continuous commitment and consistent effort. It is essential that the R50.7 billion budget allocated to the Department of Health for the 2023/2024 financial year must be utilised to address some of the challenges.
I thank you.
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