Social Development 1991 2.
Women, Children and People with Disabilities 1998 2.
Women, Children and People with Disabilities 2007 3.
Security and Constitutional Development 2017 4.
State Liability Amendment Bill [B 2B - 2011] (National Assembly - sec 75).
The Bill has been referred to the Select Committee on Security and Constitutional Development of the National Council of Provinces.
Annual Performance Plan of the Commission for Gender Equality (CGE) for 2011-2014.
Reply from the Minister of Justice and Constitutional Development to recommendations in the Budgetary Review and Recommendation Report of the Portfolio Committee on Justice and Constitutional Development on Performance of Department of Justice and Constitutional Development for 2009-10 Financial Year, as adopted by the House on 17 November 2010.
Referred to the Portfolio Committee on Justice and Constitutional Development.
The President of the Republic submitted the following letter dated 23 May 2011 to the to the Speaker of the National Assembly, informing Members of the Assembly of the employment of the South African National Defence Force for service in co-operation with the South African Police Services.
This serves to inform the National Assembly that I have employed eighty (80) members of the South African National Defence Force (SANDF), for service in co-operation with the South African Police Services (SAPS) to assist the SAPS in providing security services to me, during my visit to Libya as part of African Union negotiation team for the period 08 to 11 April 2011.
This employment is authorised in accordance with the provisions of section 201(2)(a) of the Constitution of the Republic of South Africa, 1996.
REPORT OF THE PORTFOLIO COMMITTEE ON SOCIAL DEVELOPMENT ON THE 2009/10 ANNUAL REPORT OF THE SOUTH AFRICAN SOCIAL SECURITY AGENCY (SASSA), DATED 31 MAY 2011 1.
The Portfolio Committee on Social Development deliberated on the 2009/10 Annual Report of the South African Social Security Agency (SASSA). This report presents some of the key achievements as well as challenges encountered by SASSA (the Agency). The report will also highlight matters of concern raised by the Committee.
Mr Coceko Pakade, Acting Chief Executive Officer of SASSA, explained to the Committee that the aim of the presentation was to provide an overview of the performance of the Agency for 2009/10, and also to highlight some of the financial and service delivery challenges. The presentation also reflected some short and long term measures that the Agency had put in place to address the challenges. He noted, as background information, that the Agency had a deficit of approximately R839 million incurred from 2008/09 financial year. It had an overdraft of approximately R410 million as of 31 March 2009. Therefore, it had to maintain a balance of increasing the demand for services and reducing the deficit. To address this challenge, it adopted an accrual basis of accounting.
3.2 million in 1998. However, despite this rapid increase, the staffing levels of the Agency had not increased. This had an impact on the service delivery. Furthermore, the Agency was still using a predominantly manual system of grant application and approval, which resulted in a number of files of beneficiaries and applicants having gone missing.
Mr Coceko reported that during the year under review, the number of social grants beneficiaries increased by 7.5%, from about 13 million in 2008/09 to just over 14 million in 2009/10. The 14 million is made up of 10 million children beneficiaries; 2.5 million older persons and 1.26 million people with disabilities. The average number of transactions that SASSA had dealt with during this financial year had increased from about 3.7 million in 2008/09 to approximately 4.6 million, excluding payments. In 2009/10, there was an increase of up to 1,031,261 in grants uptake which represents a growth rate of 7.5%. There was however a decrease in the uptake of disability and war veterans grants. The decrease in the disability grant was due to an intensive review process which led to 90% reduction in temporary disabilitygrant backlogs.
Disability Grant 1,408,456 1,286,893 1,264,477 -121,573 -1.
Old Age 2,229,550 2,390,543 2,546,657 160,993 6.
War veterans 1,924 1,500 -284 -424 -18.
Care Dependency 102,292 107,065 110,731 3,666 3.
Child Support 8,189,975 8,765,354 9.570,287 804,933 9.
Foster Child 454,199 474,759 510,760 36,001 7.
Grant in Aid 37,343 46,069 53,237 7,168 15.6 3.
Comprehensive and Integrated Social Security Administration and Management Services.
The Agency had achieved an increase of 1,032,261 in grants uptake which represented a growth rate of 7.5%. There was a decrease in total disability and war veteran grants by about 121,000, and 424 respectively. The decrease on disability grants was largely due to intensive review and lapsing of temporary disability grants.
Age Equalisation The Agency set a target to reach 129 662 men beneficiaries aged 61 and 62 by 31 March 2010. In total, at the time of reporting, 100 358 males in this age group (61 and 62) were in receipt of older persons grants. Thus the Agency achieved 77.4% towards reaching its target. Partial achievement of this target was due to a number of reasons: for instance, some people did not have identity documents; there was inadequate marketing of new reforms and in some areas there was still a lack of access to SASSA offices.
Gradual Expansion of Child Support Grant (CSG) The Agency had set a target to extend the Child Support Grant (CSG) to about 970 369 beneficiaries who were over the age of 14 years. A total of 673 553 children who were over that age were in receipt of a CSG which represented an achievement of 69.4% towards reaching the target. The target was not achieved due to the fact that the effective date of implementation was planned to be 01 April 2009 but the actual implementation date was 01 October 2009.
The Agency had set a target to develop and implement the following systems: (i) Improved Grant Application System (IGAP), (ii) Management Information System (MIS) and (iii) ERP. The target to implement the IGAP to five provinces was not achieved due to insufficient budget allocation. The implementation of the IGAP was still limited to the Free State region only. The ERP system was fully implemented; however i-models could not be rolled out to regions due to the magnitude and complexity of the work to be done.
The Agency had set a target to increase percentage of beneficiaries notified of administrative actions and to improve systems for administration and management of reviews. The Committee was informed that 97% of the targeted beneficiaries were notified of administrative actions prior to lapsing of grants. The development of a computerized data quality management system was not achieved due to lack of funds to acquire external expertise. Due to the delay in approval of legislation, the internal review mechanism was not implemented.
The Comprehensive Payment Management Framework was developed and approved but not fully implemented due to litigation challenges. At the time of the briefing the Agency was revising its approach to improve the payment system in South Africa. A strategy to promote electronic payments as alternatives to cash payments was implemented. This resulted in 23.4% reduction in cash payments from 6.3 million to 4.8 million.
Six targeted regions had implemented the prioritized elements of the Disability Management Model which include the gate keeping, medical assessment and medical form modules. This resulted in substantial savings for the Agency. The implementation of the three months waiting period before reapplication for a disability grant significantly decreased the temporary disability grant application. In order to minimize fraud in the processing of disability grants, the Agency introduced Medical Assessment forms with serial numbers.
The Agency planned to develop and implement the prioritised elements of the Customer Relationship Management and the Integrated Community Registration Outreach Programme (ICROP). However, the development of the ICROP Strategy was not achieved. Nevertheless, services were taken closer to potential beneficiaries, especially to those in the deep rural, areas using mobile units. All regions together with other critical government departments had implemented community outreach programmes through the participation of the Premiers in the Outreach Programme. The strategy for the implementation of the Customer Relationship Management was not approved - however some critical service delivery initiatives were implemented in some local offices to improve customer experience. These included, enquiry management, queue management, customer care charter, booking system and capacity building on Batho Pele principles.
The Agency developed the draft service delivery model. It was planned to be finalised in 2010/2011.
Under this priority, the objective of the Agency was to enhance its efficiency and improve access to its services. The development and approval of most internal control policies were achieved, however, there was still more work that needed to be done to implement some of these policies. Access to the Agency services in most local offices and pay points was improved even though it still had some challenges to address. It also invested in infrastructure improvement at various pay points across the country and it continued with the efforts to market its services. It had implemented Corporate Compliance Model to six regions and 91 inspections were conducted in six regions.
Litigation The implementation of the litigation strategy resulted in the reduction of litigation cases from about 15 212 in 2008/09 to approximately 2 735 cases in 2009/10. This reduced litigation costs from about R40 million to R20 million.
Financial management The Agency migrated from cash to accrual basis of accounting. It also reviewed and implemented financial controls, policies and procedures in line with GRAP standards.
The Agency adopted a zero tolerance approach to misconduct and that resulted in 191 cases being finalized and varying sanctions imposed. It however, identified challenges around the management of poor performance and consequently, Individual Poor Performance Management Guidelines were developed to capacitate supervisors.
Health Screening programmes were conducted to detect and treat diseases, including blood pressure, cholesterol, sugar screening, HIV and AIDS.
The implementation of the Fraud Management Strategy resulted in a saving of R180, 9 million.
8 383 persons signed an acknowledgement of debt (total value R51.2m).
An annual Internal Audit Coverage Plan was developed and implemented. The Plan clearly articulates the areas of focus for the financial year.
It was reported that there was overcrowding in some areas service points. This was attributed to beneficiaries sleeping over at the service points and early arrivals. It was further reported that long waiting periods in waiting rooms, repeat visits by clients and lack of adequate office accommodation were amongst the challenges encountered in various service points.
It was reported that poor conditions in some of the pay points were one of to the challenges facing the Agency. A large number of the pay points did not provide humane basic facilities. Most rural pay points needed urgent infrastructural attention. In addition, the Agency continued to receive cases of exploitation of beneficiaries by merchants and money lenders.
The physical infrastructure in some of the Agency's registries did not meet the requirements of the Occupational Health and Safety Act.
The Agency faced a challenge of the lack of adequate filing space and this resulted in multiple registries which carried costs.
There were some files and other critical documents that were missing.
II Reviews The Agency reported that it had significant backlogs in reviews resulting in over payments to non-eligible beneficiaries.
The dependency of the Agency on the Department of Social Department and the Department of Justice office spaces results in either payment of grants without a mandate or suspension of payment leaving vulnerable children without support.
The nature of the Agency's business had made it to be vulnerable to fraud and corruption.
The perceived inability of the Agency to successfully deal with the fraud challenges resulted in a loss of credibility.
The table below shows the progress SASSA made in addressing some of the matters of emphasis that were identified by the Auditor-General in 2009/10.
The Auditor General issued a Disclaimer Opinion to SASSA as it was unable to obtain sufficient appropriate audit evidence to provide a basis for an audit opinion.
o Incorrect or non-application of the basis of accounting; and o Incorrect or no provision for significant liabilities, in particular legal fees.
The Agency only submitted its financial statements for auditing on 10 August 2010 and not on 31 May 2010, as required by the PFMA.
The National Treasury granted SASSA an extension of three year for it to address and put in place internal controls and systems to improve service delivery. However, the extension proved to be insufficient to ensure readiness for the implementation of GRAP accounting and reconstruction of all comparative figures of 2008/09.
During the year under review, the Agency changed from modified cash to accrual accounting. It also implemented the new Oracle ERP system which resulted in reconciliations not performed as some modules were implemented late.
The Agency should conduct awareness campaigns to educate communities on age equalization on the Old Age Grant for male beneficiaries of 60 years, and the extension of Child Support Grant to 18 year old beneficiaries.
The Agency should improve the review of social grants. The Committee had expressed concerns over the lengthy review period of social grants.
The Department and SASSA should put more focus on Monitoring and Evaluation measures and on risk management as they are critical tools to curb the challenges faced by the Agency.
The Standing Committee on Finance, having considered the request for approval by Parliament of the Republic of South Africa of the Agreement on the Establishment of the African Tax Administration Forum, recommends that the House, in terms of section 231 (2) of the Constitution, approves the said agreement.
The Committee, as mandated by the Constitution and Rules of Parliament, undertook an oversight visit.
Investigate the high incidence of infant and maternal mortality rates in the Province.
Interventions by the Eastern Cape Provincial Department of Health.
Investigate the high numbers of youth deaths attributed to initiation and the interventions by the Provincial Department in this regard.
Assess the implementation of the Mother to Child Transmission of HIV/AIDS in the Province.
Investigate infant mortality rates in the province.
Conduct site visits to Voluntary Testing Centres.
Objective Four: Oversee related initiatives and overseeing the implementation of programmes aimed at assisting socially vulnerable groups.
Objective Five: Overseeing programmes, policy and legislation relating to the improvement of the health profile of all South Africans.
In relation to the work of the Select Committee on Women, Children and Persons the issues on maternal death, infant mortality mother to child transmission of HIV/AIDS relates directly to the Committee's focus on gender issues.
The outcomes of this oversight visit will capacitate the Committee to make substantial recommendations to the improvement of the quality of lives of the women in the Eastern Cape and KwaZulu Natal Provinces. This oversight visit relates not only to the strategic priorities of the NCOP as outlined above but also the five year strategic priorities of the Committee in terms of its priority of survival and development. This oversight visit also had a basis in terms of the Millennium Development Goal 4 which relates to the reduction of under-five child mortality rates.
Hon. B.P. Mabe (ANC); Hon G.G. Mokgoro (ANC); Hon Mashamaite (ANC), Hon D.
The presentations by the department related to infant and maternal health statistics and its underlying causes, as well as departmental challenges and the strategic interventions to address these challenges.
On its infant mortality statistics for the 1st quarter of 2010, the department noted that the statistics were only a reflection of mortalities that occurred within the hospital and did not include mortalities that occurred within communities.
Its infant mortality rates were exceptionally high, but the department was developing strategies and interventions to address this issue. The statistics did not reflect underlying conditions as to the cause of death, which included HIV/AIDS malnourishment, and late detection of birth defects. Furthermore, the statistics are also inclusive of infant deaths as a result of incomplete abortions, which were not disclosed to the doctors at the time of delivery. Unregistered abortion practitioners continue to be a problem in the province and the department has taken active measures to investigate this problem. The department further acknowledged that a large proportion of deaths could also have been prevented given the appropriate antenatal care and early detection of problems and abnormalities in early pregnancy.
The age range of the maximum numbers of maternal death range from 18-35, with most of the maternal death numbers attributed to young teenage mothers. Cultural and social pressures prevented these mothers from seeking early antenatal care. The infant mortality statistics was also inclusive of incomplete abortions.
The Eastern Cape is a vast province with a historical backlog of poor infrastructure. This has increased the challenges within the province.
It was noted that the province is highly under-capacitated in terms of its number of ambulances. At present, the ambulances are not stationed at the individual hospitals, but at a central facility that allows it to service an area often spanning 100kms. This is further compounded by vast distances between clinics to referring district and provincial hospitals. Normal deliveries are attended to at the local clinics but should there be complications in the delivery or with the foetus, these cases are referred to the district and provincial hospitals which are able to provide a higher level of intensive care. Furthermore, the existing ambulances are not stocked with incubators or oxygen, which is further exacerbated by the fact that there are insufficient medical personnel in the ambulances that can maintain a stabilized patient en-route to the nearest district or provincial hospital.
Insufficient ambulances also contribute to the poor management of patients, as patients that have been discharged to their local clinics often wait days to be taken to their hospital of origin. Furthermore, the department does not have an electronic database through which it manages its patients.
The province has a chronic shortage of doctors and nurses, for example, some district hospitals may have the equipment for intensive care but do not have the nurses to staff it. Furthermore, the province, particularly in rural areas, faces difficulty in attracting qualified doctors and nurses. This difficulty is mainly due to the lack of appropriate accommodation in rural areas for doctors. The department was working on measures to address this challenge together with the Department of Public Affairs and Administration as this issue presents a major challenge in respect of retaining doctors and nurses in rural hospitals and clinics that are struggling with insufficient medical personnel.
X- Ray machines, foetal monitors, equipment to monitor the progress of labour, insufficient incubators are just a few of the key medical equipment that hospitals lack. This equipment is essential in order for the medical personnel to perform their duties. In terms of medicines, hospital supplies, particularly in relation to chronic medication, which is very quickly depleted as some hospitals are more accessible to rural communities than some of the local clinics.
This presents a major challenge and is mainly due to the poor referral system between hospitals. This challenge is exacerbated by insufficient ambulances which results in patients that have been stabilized and that are able to return to local hospitals or clinics and are forced to remain at the district and provincial hospitals longer than necessary. This increases the risks 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.
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 of high risk patients.
Though the department presented the statistics to the committee, it refused to release data to the committee when further requested.
The committee requested information from the province on the high number of youth deaths as a result of initiation. The department indicated that it was a major problem in the province, and their involvement came when the youths were admitted to hospitals. The department does not have an active strategy to deal with this issue. However, it has been in consultation with the Department of Co-operative Governance and Traditional Affairs to address this issue. This problem also required greater involvement and greater responsibility of the traditional leaders and that is an ongoing process.
In terms of initiation, the problem needs to be more actively managed within communities.
Department of Co-operative Governance and Traditional Affairs and communities. There is a need for more support and outreach to families in the communities and the initiatives of the department in this regard.
The department furthermore needs to play a more active role particularly in terms of education to the youth about family planning, the prevention of HIV/AIDS and sex education. This needs to be done collaboratively with the Department of Education.
Further support in the communities in terms of training for women that can assist with various aspects of prenatal and antenatal care to pregnant mothers.
The need for local clinics to be more accessible.
The need for greater decentralisation of services that will facilitate greater accessibility of services and a responsive department to the needs of rural communities.
In terms of staff retention, the department needs to create more incentives to lure doctors to the rural areas. It needs to be done through addressing infrastructural challenges in the province in terms of appropriate accommodation in rural areas.
The purpose of the oversight visit to Nelson Mandela Academic Hospital was to conduct a site visit of the facility in terms of their maternal and antenatal wards.
The Nelson Mandela Academic hospital echoed the challenges as presented by the Provincial Department of Health. The challenges experienced on a macro provincial level were the same as those experienced on a micro community level. As an institution, the hospital struggled with the same challenges, and as the only such facility within a 250km radius, excessive pressure is put on the hospital to provide high risk and emergency care. Though the hospital is able to meet this challenge, it struggles particularly with overcrowding as mothers who have been discharged to their local and district hospitals often wait for days to be transported. This exacerbates an existing challenge of overcrowding within the hospital.
Insufficient incubators for preterm babies resulting in babies having to share incubators, though this is not in accordance with health regulations.
Large waiting rooms of post delivery patients waiting to be taken to the local hospital or clinic.
A high level of hygiene maintained within the hospital facility.
The St Barnabas hospital services 17 local clinics, is a level 1 district hospital. It refers high risk patients to Nelson Mandela Academic Hospital some 120 Kms away. The hospital has a capacity of 189 beds but is often overcrowded due to its central location near a major road. The key programme of the facility is to strengthen primary health care.
The key challenges highlighted by the institution was that of a chronic shortage of doctors, urgent need for government intervention in respect of integration planning, and more incentives for doctors to work in rural areas. There is a lot of infrastructural investment which is not matched with the development of infrastructure for the doctors and other professionals that need to work at the hospitals. Furthermore, the hospital also has a shortage of medicines due to its proximity to a major road. Most residents of rural communities that would have received chronic medication from their local clinics now receive their medication from the hospital. This depletes the hospital's supply of medication.
In respect of infant mortality, the hospital noted that these were not necessarily due to negligence of doctors, but rather the provincial problems of the Eastern Cape Provincial Department of Health duplicating itself at a micro level. Shortage of funding, and 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 24-hour services in terms of key areas like radiography, as a result of the limited radiographers in the province. Furthermore, the hospital has facilities for intensive care, though it does not have the staff capacity to sustain this level of care.
The committee conducted a site visit of the facility and noted the challenges highlighted by the hospital.
The clinic 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 clinic services large volumes of clients, and in the past six months it serviced 6000 patients. Though the clinic is faring well in the process of being extended, the challenge it faces is with regards to human resources. The Eastern Cape Provincial Department of Health is in the process of negotiating conditions of service and transfer agreements with the local municipality.
The purpose of the meeting was to assess the implementation and 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. In its introduction, the provincial department noted the HIV/AIDS prevalence in the province which as of 2008 was 38.7% of the population. In terms of demographics, 46% of the population is under the age of 20%. This places a major focus on education in respect of HIV/AIDS awareness and prevention as well as family planning and social services.
In respect of the province's demographics, the majority of its population are children and youth, and its health programmes therefore have a strong focus on those groups. A study further noted that the majority of deaths of children under the age of five years happen not within hospitals and clinics, but within communities. The Child Survival strategy therefore focuses on communities. In terms of a provincial study conducted in 2008, it was determined that in respect of the deaths of children under five years old in the province, malnutrition was the underlying cause. The department initiated preventative measures which seek to address issues of child survival within communities. The aim of this programme is to promote intersectoral collaboration, to cascade community programmes and reduce the main causes of deaths amongst children. The Provincial Department of Health works collaboratively with the Departments of Education, Agriculture, Social Development, Home Affairs as well as NGO partners in terms of providing a range of services which deal with education, immunisation, economic empowerment, nutrition and social support grants which contribute towards the reduction of deaths of under five year olds in the province.
The PMTCT programme of the Department of Health falls under the area of maternal health, and is the flagship programme of the KwaZulu Natal Provincial Department of Health. This programme aligns itself with the Millennium Development Goals as it relates to the reduction in maternal death and the department through this programme, is actively trying to meet the MDG targets. In respect of the main causes of maternal death in the province, infection, as a result of HIV accounts for 45% of maternal fatalities. According to a study conducted in 2008, latest statistics show that KwaZulu Natal has a HIV prevalence of 38.7%, which rates as one of the highest in the country. As mentioned previously, the province has a predominantly youth population. The purpose of the programme is early determination of the HIV status of mothers to prevent the transmission of HIV/AIDS to infants either during pregnancy and delivery. This is a free programme that focuses on early detection, counselling and the management of the anti-retroviral medication to HIV positive mothers during pregnancy and delivery. The CD4 count of the HIV positive mothers is closely monitored both during pregnancy and delivery. Post natally, the mothers also receive training on infant feeding and follow up home visits, and this facilitates management of HIV/AIDS within the home.
In terms of the prevention of mother to child transmission of HIV/AIDS, early booking of pregnant mothers is essential and this programme forms part of antenatal care. The provincial department has aligned this programme to the five year provincial strategy. Furthermore, the province has twenty hospitals providing specialized care to HIV positive mothers in labour and a further sixty-seven clinics providing PMTCT. At present, the department is able to provide anti-retrovirals to 94% of babies of HIV positive mothers.
The biggest challenge the provincial department has in respect of implementation of this programme is funding. At present, the demand of the province is not matched by the funds allocated to it. The province should have an average additional R17 per capita per annum funding to fully meet the needs of the Province. This minimum is also required to meet the Millennium Development Goals.
Hospitals and clinics in both provinces had some similar challenges and key issues within their health structures.
Lack of ambulances and insufficient emergency medical personnel.
Poor management of patients (referrals).
Insufficient doctors and nurses in the province.
Shortage of medicines and other essential medical equipment.
Overcrowding in hospitals.
Accommodation for doctors.
Insufficient funds to accommodate.
Lack of incubators and oxygen tanks in the hospital and ambulance.
St Barnabas only has one ICU nurse. Clinic needs more personnel.
No X-ray facilities after hours.
A need for radiography specialists.
A need for specialized scrub nurses.
High prevalence of HIV/AIDS.
Hospital administration requires funds for PMTCT programmes as per PEPFAR (U.S.
Funding will be withdrawn.
In order to meet MDG targets on maternal mortality, hospital officials suggested an increase of R17.00 per capita on the budget.
The Select Committee on Women, Children and Persons with Disabilities noted the manner in which the Eastern Cape and KwaZulu Natal Provincial 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 terms of capacity, infrastructure and resources and the negative impact that this has had on service delivery.
After conducting site visits and observing first hand the dynamics prevalent in all the facilities visited, the committee is then in a better position to understand these challenges.
The Committee, as mandated by the Constitution and the Rules of Parliament, undertook an oversight visit.
The oversight visit is informed by the NCOP's key strategic priorities as well as the Committee's five year strategic plan.
To investigate allegations of neglect and inhumane living conditions for mentally disabled patients.
To investigate interventions by the Limpopo Provincial Department of Health and their plan of action for disabled persons in the Province.
To investigate the accessibility and disbursement of social support grants and support provide through the Limpopo Provincial Department of Social Development and the South African Social Support Agency.
To meet with the Commission on Gender Equality and get a briefing on work done in the Province and progress made in respect of its turnaround strategy.
To meet with the Tshwaranang Legal Advocacy Centre for Women to discuss their work in relation to implementation of the Domestic Violence Act 116 of 1998. Mokgoro (ANC); Hon Mashamaite (ANC) and Ms Mahdiyah Solomons (Committee Secretary).
The specific areas of focus were on issues of mental health and the Province's response to them. The oversight visit was specifically conducted in response to allegations of neglect of mentally ill patients at the old Nkhensani Hospital in Giyani and the Limpopo Provincial Department of Health's response to them. Three facilities in Giyani were visited: Nkhensani District Hospital, Evuxakeni Hospital and the Pfunanani Special School, with a focus on issues relating to people with disabilities.
The Evuxakeni Hospital is a district hospital in Giyani in the Limpopo Province. The hospital has the capacity to accommodate 400 patients. The hospital currently attends to 280 patients including the patients transferred from the old Nkhensani Hospital. Patients from the Nkhensani Hospital were moved to Evuxakeni Hospital in 2010 as a result of media coverage exposing poor living conditions for mental health care users. Female patients were moved first and the last of the male patients were moved at the end of December 2010. All patients and psychiatric staff were moved to the Evuxakeni Hospital.
A Mental Health Review Board's role is to ensure that the care, treatment, and rehabilitation of persons who are mentally challenged conform to the Constitution and the Bill of Rights. The members of the board should include a legal expert, a mental healthcare practitioner and a community representative.
A Mental Health Review Board was established in Gauteng under the leadership of the Gauteng Department of Health and Social Development MEC, Ms Qedani Mahlangu. Its aim is to visit 100 psychiatric hospitals and mental health non-governmental organizations (NGOs). The aim of the visit is to monitor whether the institutions comply with the Mental Health Act No. 17 of 2002 which aims at ensuring that the rights of those with mental disabilities are protected.
Approximately 80% of the male patient population presented with substance- induced psychosis. A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs or alcohol, medication and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (TIK), cocaine and other drugs including cannabis.
Currently patients use older drugs. While effective, they have in some cases caused negative side effects in patients. The Evuxakeni Hospital psychiatrist indicated that new medication had proven more effective in private patients who have been treated with it.
There is a need for a dedicated structure or ward for mental health care users. Currently the hospital is not adequately equipped with the necessary infrastructure for these patients. Hospital senior personnel had indicated that a new ward had been budgeted for with the aim to commence building in January 2011.
The structural foundation of the hospital is weak due to soil erosion and moisture damage, making expansion of the new psychiatric ward difficult.
Given that budget has been allocated in 2010, has the Department made contingency plans with National Treasury to extend the budget timeline before the new financial year begins?
The oversight visit revealed that many of the younger patients are spending most of their time in beds. What programmes are in place to ensure patients are stimulated and enjoy a good quality of life?
Given that many of the patients are presenting with substance induced psychosis, what community based interventions are in place to address the abuse of alcohol and drugs?
Does a Mental Health Review Board exist in Limpopo If so, is it functional If not, are there plans to establish one for the Province?
What programmes exist to educate parents and family members on patients' mental health issues?
The Pfunanani Special School accommodates children of all ages with mental disabilities and severe learning and educational difficulties. Currently the school accommodates 556 students, 358 stay in hostels on the site and the rest use public and private transport to attend the school. 256 of the total school population are currently receiving grants. The school currently has 22 fixed classes and 11 mobile classes and consists of 35 teachers and 29 non-teaching staff. To date there are approximately 494 children from the surrounding Limpopo area waiting to attend the Pfunanani Special School.
As of 2011, parents pay R200 per year for day scholars and R1 000 per year for boarders.
The school offers needlework, home economics, hairdressing and bead making as part of their skills development programme.
Lack of staff when children need to go to hospitals at night.
Difficulties staff encounter when children have to be admitted to hospital. This is due to the fact that hospitals require children to be accompanied by parents to be admitted.
Poor quality of the kitchen and cooking facilities.
There is a need to build a school infrastructure to provide students with the best quality education. In a proposal to the Pfunanani Special School it was indicated that construction of the new school would commence in 2006, 5 years later the first phase of construction has not begun.
There is a need to provide facilities for students once they reach the age of 18.
What has been the delay in constructing this school Has a budget been allocated?
There appears to be a lack of mental health professionals at the facilities visited. What plans have been put in place to ensure professionals are made available to the patients and students?
What programmes are in place to accommodate students who leave special care facilities?
As pointed out earlier, after wide media coverage on the poor living conditions, psychiatric patients were moved from the Nkhensani Hospital to Evuxakeni Hospital.
What will happen to the building previously inhabited by the patients of the psychiatric ward?
As per hospital personnel the facility was deemed unfit for humans to inhabit approximately 4 years ago. Why had it taken media pressure to move patients?
Are there plans to refurbish any part of the facility?
Though the patients had been moved to the Evuxakeni Hospital the delegation observed the conditions in which the patients and staff had until recently had to live and work in.
Members noted that intended to have their questions and concerns responded to in the meeting with the Limpopo Provincial Department of Health on the 28 February 2011.
The Department made a presentation to the Committee in terms of its mental health programme. The Department further made a presentation to the Committee in terms of its challenges and strategic interventions to address these challenges.
The Department noted that its services were divided into three levels of care, namely tertiary, secondary and primary. The province had three specialized hospitals and only one with a high level of security for convicted criminals and acute patients. The province is struggling with limited capacity in terms of psychiatrists and registrars and is embarking on an intensive retention programme to attract and retain qualified psychiatrists and registrars in the Province.
Outreach is done at secondary level hospitals and district hospitals. The Department is in the process of bridging the gap between institutional services and community services. Furthermore, the Department is also in the process of training psychiatric nurses to conduct follow up services in communities and particularly in rural areas. The Department is working closely with educational technical colleges in this respect.
Psychiatry is a specialized service and is not available at all hospitals. There are three hospitals in the province that deal with specialized care for acute patients, which results in many patients from rural areas having to travel extensive distances in order to get the services they require. This challenge is further compounded by the fact that there are not sufficient psychiatrists and psychiatric nurses deployed to these hospitals. The absence of a Mental Health Review Board further exacerbates this problem.
One of the major challenges in the Province is the absence of a provincial Mental Health Review Board. The Department acknowledges that it is contravening legislation by not having one and plans are underway for the Department to fast track this process. The Department indicated that one of the causes for the delay in establishing the Board was the deadlock that had been reached in respect of the stipend that needed to be paid to Board members. This has since been resolved and adverts have already gone out. The Department expects the Board to be fully operational by 1 April 2011.
The Department acknowledged that the psychiatric patients were expected to move to the new Nkhensani Hospital; these were in the initial plans. However, due to time and other constraints, there were more problems than anticipated. Problems included plumbing, poor workmanship etc. This resulted in the ward for psychiatric patients not being built, and alternative arrangements for their care to be made at the Evuxakeni Hospital which is part of the hospital revitalization programme.
The Department further noted that the old Nkhensani Hospital has been deemed uninhabitable and the condition of the building has deteriorated to such an extent that the building had to be demolished. Short alternative accommodation has been made available at the Evuxakeni Hospital, though the conditions there were not ideal either; it met the requirements in respect of space and security, in the short term. Plans are currently underway to extend the psychiatric wards at Evuxakeni and make them more suitable. The Department is struggling with the pace at which the Evuxakeni Hospital is being revitalized.
In respect of budget, funding has been made available for psychiatric ward services for the 2011/2012 financial year. The Department further acknowledged that the maintenance and refurbishment of hospitals were the responsibility of the Department of Public Works.
The skills retention strategy of the Limpopo Provincial Department of Health.
Concerns over the absence of the Mental Health Review Board.
The extent of family involvement in the lives of these patients.
Poor referral systems.
Poor condition of facilities.
The Select Committee on Women, Children and People with Disabilities took a decision in 2010 to conduct a site visit to the Head Offices of the Commission for Gender Equality (CGE).
Receive a presentation from the CGE on its plan of action in Provinces.
Receive a follow up presentation from the CGE on its Turnaround Strategy as presented to the Committee.
Receive a progress report from the CGE on key recommendations emanating from the Strategic Report of the Public Hearings on Gender Based Violence.
The Committee was joined by the Standing Committee on the Status of Women Youth and Persons with Disabilities of the Gauteng Provincial Legislature.
Commissioner M Shozi, Acting Chairperson of the CGE made a presentation to the Committee in respect of the issues raised above.
In respect of monitoring and service delivery in respect of the Domestic Violence Act, the CGE noted the lack of training by law enforcement officials, most notably police as to how to handle cases of domestic violence and the issuing of protection orders. In most cases the protection order comes too late to take the victim of domestic violence out of the immediate danger that she is in. This is furthermore exacerbated by the fact the law enforcement officials try to mediate the situation, whilst not being trained to do so or are biased towards the victim. This often results in the fatalities of these victims who enrage their attackers even further once the police have left. Training to law enforcement officials is provided in terms of the correct procedures, contact details of places of safety and worksheets.
The CGE further notes that the Domestic Violence Act is silent on the role of the CGE and the Commission would therefore propose amendments to the Domestic Violence Act to the effect that the CGE should monitor the implementation of the Act.
Lack of co-operation on the CGE's monitoring role from stakeholders.
Public perception of the CGE with regard to service delivery - this relates to the negative publicity received in respect of the Auditor's General's findings on the CGE.
Lack of co-operation from government - as a gender monitoring and lobbyist institution the CGE struggles to receive the necessary reports from government departments which inform their national monitoring on gender programmes.
The small number of staff allocated to provincial offices versus the vastness of provinces.
The CGE furthermore has an unfunded mandate in respect of the Promotion of Equality and the Prevention of Unfair Discrimination, which obligates the CGE to institute proceedings of unfair discrimination on the grounds of gender. The CGE is legislated to implement this policy; however funding provision has not been made available to enable the CGE to do so.
It exercised its subpoena power in respect of the Commission on Gender Equality Act of 1996.
Efficient use of resources to fulfil the mandate of the CGE.
Creating more visibility in the provinces and facilitating public awareness of the mandate of the CGE.
Recognition and participation in International bodies.
The Eastern Cape office is leading a consortium of the Commission, including the National Prosecuting Authority and the South African Human Rights Commission in an attempt to collectively lobby and challenge the issue of forced marriages (Ukuthwala), which is particularly rife in that province.
In Mpumalanga, an awareness programme for men around gender based violence and facilitating public awareness of domestic violence and HIV infections related to rape and sexual assault is in place.
In the Kwazulu Natal Office, harmful cultural practices relating also to Ukuthwala, virginity testing and male initiation, focussed intervention include public awareness as well as Dialogue's held to determine whether traditional practices still hold relevance and whether or not these practices are still held within the ambit of culture. Specific focus is on whether or not cognisance is taken of the Bill of Rights on these issues. The provincial office is furthermore spearheading pilot workshops on maternity benefits for pregnant women; the purpose of these workshops is to identify policy gaps to address this issue and the practical impact on working women.
As a National Office, the CGE is furthermore making representations on legislation tabled in Parliament and lobbying in terms of gender issues.
The CGE is further in the process of addressing legal issues relating to Chieftaincy cases, Court monitoring in respect of the functionality regarding gender and championing the issue of inheritance in respect of Recognition of Customary Marriages and Interstate of Succession.
[The CGE particularly mentioned the non functionality of the Equality Court and requested the Committee's intervention in respect of this issue.
CGE are also in the process of conducting and completing various research papers which will be tabled in Parliament in 2011/2012.
The accessibility of CGE provincial offices, particularly in rural communities.
The poor enforcement of maintenance orders and the CGE's role in this.
The need for CGE to have more qualified attorneys so as to play a more active championing role in legal processes.
The CGE need to actively work to changing the negative image created by its past poor performance. Positive performance and results will result in positive publicity.
Tshwaranang Legal Advocacy Centre is a multi-disciplinary centre that promotes the rights of women to live free of violence and have access to adequate and appropriate services. This is done through the provision of free legal services and litigation, public education, research and advocacy.
The Tshwaranang Legal Advocacy Centre (TLAC) to End Violence against Women was established in 1996 to eradicate the victimization of women by the legal system, and to make the law a vehicle of social change for women. TLAC played a key role in the development of the Domestic Violence Act, holding membership on the project committee of the South African Law Reform Commission that drafted the Bill. TLAC has undergone a range of work since its inception, including training and education, advocacy and research.
In 2005, TLAC established a legal services unit that provides information and legal advice and assistance to women who are survivors of gender based violence, including domestic violence and rape. The unit also provides legal advice on maintenance and is undertaking a programme of capacity building for non-legal NGOs to increase access to these services for poor women.
TLAC has participated as a member of the National Working Group on Sexual Offences since the group was formed and is currently responsible for the national coordination and ensures the implementation of the workings and activities of the Group.
The monitoring of metro and South African Police Service officers, who make unlawful arrests of women and then proceed to assault and rape them -this presents a broader problem of male bias once the affected women report these cases.
Maintenance cases and legal support for women.
The delegation resolved to conduct follow up meetings with the Departments of Justice and Constitutional Development and the South Africa Police Services in terms of the issues highlighted above.
Whilst no commitments were made in respect of the Limpopo Provincial Department of Health, the delegation mentioned its intention to have further follow up engagements with the Department in respect of the accommodation for the mentally disabled patients at the Evuxakeni Hospital in Giyani, Limpopo.
Assist the CGE in promoting a national workshop for law enforcement officials in respect of issues related to gender based violence.
Address the non-functionality of the Equality Courts.
Champion the review of the unfunded mandate of the CGE in terms of the Promotion of Equality and Prevention of Unfair Discrimination Act.
The Select Committee on Women Children and Persons with Disabilities noted the manner in which the Limpopo Provincial Departments of Health and Social Development, the South African Social Security Agency and the Commission for Gender Equality have organised themselves to work towards implementing policy directives and programmes in improving the lives of women and the mentally disabled. The Committee has furthermore observed the challenges faced by these institutions on the ground, particularly in terms of capacity, infrastructure and resources and the negative impact that this has had on service delivery.
After conducting site visits and observing first hand the dynamics prevalent in all the facilities visited, the Committee is then in a better position to understand these challenges.
Report of the Select Committee on Security and Constitutional Development on Budget Vote 24: Department of Justice and Constitutional Development, dated 8 June 2011.
The Select Committee on Security and Constitutional Development, having considered Budget Vote 24: Department of Justice and Constitutional Development reports that it has concluded its deliberations on it and recommends that the Council approves Budget Vote 24.
A more detailed report on the committee's observations will follow in due course.