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MosselbayonTheline | First With The News

Die hewige polemiek oor die regering se planne om gesondheidsorgdienste te nasionaliseer, raak elke inwoner van die land. Enersyds kan net sowat 15% - 20% van die land se inwoners deesdae 'n omvattende mediese fonds bekostig en andersyds is die openbare gesondheidsektor só ondoeltreffend weens kritieke geld- en personeeltekorte dat pasiënte daagliks sterf of ure lank moet wag vir basiese voorskrifmedisyne. Mediese sorg by die oorvol klinieke is in die meeste gevalle ook beperk tot pynpille en antibiotika . . . 

Onderstaande artikel het in 2015 reeds in GROUNDUP verskyn . . . en vandag lyk die situasie eerder erger as beter. Enige pasiënt wat al van die openbare gesondheidstelsel gebruik moes maak, sal met minstens 'n paar van die probleme en frustrasies kan identifiseer:    

Waiting, waiting and waiting for the doctor

It is 5:40am on a misty Friday morning and there are already a group of people huddled together on the stone bench outside Town Two Clinic in Khayelitsha. Many of them have been here since 4am as they know that by 7:30am, when the clinic opens its doors, the queue will reach down the street.

The first patient in the queue, Nelson Nyudu, says that he will probably be seen at 8 or 9am, more than four hours after he arrived at the clinic. Regardless of the weather, patients must wait outside as the clinic does not open its doors before 7:30am.

“We stand here even in the pouring rain,” says patient Noluthandla Mange. “We have been complaining for a long time. They tell us to put the complaints in a box but they never do anything about it.”

This is contrary to directives from the Western Cape Department of Health. Marika Champion, who is director of communications for the Western Cape Department of Health, says, “We encourage patients to engage directly with facility management on site to air their views and offer some suggestions for improvement.”

Mange, who suffers from asthma, says that she hasn’t got the money to travel to other clinics in the area, where patients are allowed to wait inside before the official clinic opening times.

“What we would like to see the clinic do is to allow patients inside,” says Nyudu.

Many patients waiting outside Town Two Clinic claim that they experience further delays once the clinic finally opens. They say patients picking up their medication and patients waiting to see the doctor all wait together and that this causes delays.

The problem “is the process. They don’t have a strategy,” says Noni Sopapaza, another patient waiting in the queue.

Patients say that their folders are regularly misplaced, causing further delays once they are inside the clinic.

Less than three kilometres away is Matthew Goniwe Clinic where the situation is very much the same. It is 6:30am and a number of people are waiting outside the clinic. Patients say that they expect the clinic to open at 7:30 or 8am.

The issue of misplaced folders again appears. “Sometimes they can’t find your folder. And they will ask where you put your folder,” says Joyce Malibuye who is first in the queue.

When this happens the patients say that they are sometimes asked to come back the following day or the clinic staff will open a new folder for them.

Champion acknowledges that facilities are very busy and that patients often wait for long periods of time.

“Our facilities [in the Western Cape] open at 7:30am and we encourage clients not to arrive at the facility before the opening times. Hence we have an appointment system which clients are encouraged to utilise and to honour their appointments,” says Champion.

Champion says that patients are categorised according to the seriousness of their illness or injury and that if a patient is coded “red”, which is indicative of a life-threatening injury, they will be seen immediately thus causing delays for patients coded “orange”, “yellow” or “green”.

She also acknowledges that the retrieval of folders contributes to the long waiting times. “Improvement systems are being rolled out to facilities within the province. In some cases this includes electronic systems and in others merely small infrastructure and flow improvements,” says Champion.

Champion says that the Western Cape Department tries to accurately predict patient volumes and to allocate staff and resources effectively but that this can be difficult when patient flow is unpredictable. She says that remedying the problems faced by patients at clinics is a high priority for the province.

Clinics around the country experience similar problems. Elizabeth Mahlangu is a patient at Daveyton Main Clinic in Ekurhuleni and says that patients face numerous challenges when they go to the clinic.

“There is a long queue from 4am to 4pm,” says Mahlangu. “There are only four staff nurses in the clinic.”

The clinic also does not have a permanent psychologist; instead one psychologist rotates between four clinics in one day.

Again the issue of lost files resurfaces. The last time that Mahlangu was at the clinic she was told that her file was missing, meaning that a new file had to be opened. Medicine shortages have also resulted in Mahlangu not receiving her medication.

Portia Serote who is the Treatment Action Campaign’s (TAC) national women’s representative says that TAC is very concerned about the clinics around Daveyton. She says that the shortage of staff is a major cause of the problems.

“They [the patients] chose to go to work to put bread on their family’s table rather than going for treatment as they are told to come back on other dates,” says Serote.

Serote, who is also chairperson of the clinic committee, says that the clinic receives more than 10,000 patients a month who are on antiretroviral treatment for HIV and this pressure on the facility is increasing as patients with HIV now begin treatment earlier.

She confirms that filing systems are problematic and that files often go missing. Serote says that nothing is done to address issues of infrastructure and shortage of staff.

“Some of the head facility managers are forever covering up [problems] and when the department comes down to check on the problems [the head facility managers] do not list the challenges that they are having,” says Serote.

In Daveyton Main Clinic she says that nursing sisters are often moved to departments where there is an influx of patients, despite the nursing sister not being trained to work in that particular department.

“Last month, one of the nurses who is not working in antiretroviral treatment gave a patient two drugs instead of three because it is not his specialty and he is not trained in doing that kind of job. Even in the TB department, one patient with drug-resistant TB was misdiagnosed,” says Serote.

Joe Maila, who is the spokesperson for the National Department of Health, says that the large number of patients who visit health care facilities result in the queues and that the Department is finding ways to resolve the problem.

“One of the ways of reducing queues is to roll-out chronic medical supply. So that patients who do not need to be consulted by a doctor or health worker should get their supplies directly delivered to them rather than coming to queue at the facility. This will obviously reduce queues at health facilities,” says Maila.

He also said that the Department is finding ways to manage queues at reception in order to direct patients according to their specific needs.

The deputy executive director of the Wits Reproductive Health and HIV Institute, Professor Francois Venter, says that there needs to be a change in the systems at clinics so that patients can be streamed more efficiently through the process.

“What happens is that there is an intense burst of energy in the morning and things quiet down in the afternoon,” he says.

In Venter’s 2014 discussion paper on what has been learnt from the last ten years of HIV treatment programmes, he writes: “We sit with a health delivery system largely designed by European colonisers. They’ve moved on, but we have clung to a clinic-hospital, nurse-doctor model that was out of date 50 years ago.”

Venter believes that there needs to be a more integrated way of treating patients so that they do not waste time waiting in queues. He also says that people aren’t held accountable for the problems in clinics. “There is a lot that could be done but there is no easy answer,” Venter says.

Lees ook: 

Só flop NGV rééds
Deur Johan Eybers

Peperduur loodsprojekte waarmee die regering wou wys sy nasionale gesondheidsversekering (NGV) kan werk, het ineengestort binne maande nadat die bestuur daarvan aan provinsies oorgedra is.

Hierdie projekte was ’n volslae mislukking, sê dokters en kenners – maar dr. Aaron Motsoaledi, minister van gesondheid, beskryf dit as ’n sukses. Die begroting vir die NGV is in die huidige boekjaar meer as verdubbel van R735 miljoen tot R1,7 miljard.

Belastingbetalers het die afgelope ses jaar altesame R4,3 miljard gehoes ter voorbereiding van die NGV.
Dr. Anban Pillay, adjunk-direkteur-generaal verantwoordelik vir die NGV, het aan Rapport bevestig die provinsies het die loodsprojekte op 1 April 2018 oorgeneem.
“Die meeste provinsies het die dokters aanhou in diens neem en in sommige gevalle na ander fasiliteite geskuif.”

Drie NGV-dokters met wie Rapport gepraat het, sê egter die wiele het reeds afgeval in minstens die Oos-Kaap, Limpopo en Noordwes. Die dokters is met mekaar in verbinding deur ’n WhatsApp-groep.

In die Oos-Kaap is die NGV-dokters in die pad gesteek, in Limpopo is die oorgrote meerderheid van dokters laat gaan en die Noordwes-gesondheidsdepartement is in so ’n benarde toestand dat dit onder nasionale administrasie geplaas is om weer basiese dienslewering te hervat.
In Noordwes verskaf net 39% van staatsfasiliteite aanvaarbare diens, het die interministeriële taakspan bevind.

’n Oos-Kaapse dokter sê sy is R78 000 per maand betaal en deur die jare “mislei” om te glo sy gaan met die projek kan aangaan totdat die NGV ten volle in werking tree.

In Gauteng is die programme amptelik verleng, maar ’n dokter in dié provinsie sê hulle is eers die afgelope week vir die laaste drie maande se werk betaal.

Volgens dié dokter is hulle onseker oor hoe lank hulle nog hul werk gaan behou.

“Die provinsiale departement van gesondheid weier om vir ons antwoorde te gee.
Dit lyk nou of die program tot September sal voortgaan of totdat die provinsie se geld op is. Dokters bedank nou op ’n streep.”

Die regering het in 2012 die loodsprojekte in tien distrikte oor die land heen begin en dit onmiddellik uitgekontrakteer aan ’n maatskappy genaamd Foundation for Professional Development (FPD). FPD is ’n winsgewende entiteit verbonde aan die Suid-Afrikaanse Mediese Vereniging (Sama).

FPD het dokters gekontrakteer om aan die NGV-program deel te neem en ook die doeltreffendheid daarvan gemonitor.
Dr. Gustaaf Wolvaardt, besturende direkteur van FPD, sê die projek was ’n sukses voordat dit einde Maart aan die provinsies oorgedra is.

“Die dokters het ’n beduidende bydrae gemaak om die las op staatsklinieke en provinsiale hospitale te verlig en om pasiënte met chroniese siektes te bestuur. “Ek glo dat dit op lang termyn sou kon werk as die dokters net reg bestuur is.”

Russell Rensburg van die Rural Health Advocacy Project, sê die rede waarom die projekte in duie stort, is omdat die provinsies nie in staat is om finansiële bestuur toe te pas nie en nie die vermoë het om poste te vul en gesondheidsdienste te lewer nie.

Dr. Paula Armstrong, senior ekonoom van Econex, sê die verwikkelinge plaas ’n groot vraagteken agter die departement se vermoë om die NGV op ’n nasionale vlak te implementeer.

Volgens haar is dit ook onduidelik presies wat die departement met die miljarde rande gedoen het wat reeds bestee is.

Motsoaledi het verlede week met die bekendstelling van die wetsontwerp oor die NGV gesê die loodsprojekte was ’n sukses. Volgens hom is 6 miljoen mense op ’n sentrale databasis geregistreer en uitreikspanne van die loodsprojekte het 900 000 mense by hul huise besoek om dienste te lewer.

Hy het gesê sedert 2012 is R1,7 miljard bestee aan nuwe toerusting en meer as R40 miljard om hospitale en klinieke op te knap. Dié uitgawes kom egter uit ander begrotings as die NGV s’n.

Die NGV-projekte was volgens Motsoaledi “moeder-en-kindgesondheidsprogramme, streek-spesialisspanne en primêre gesondheidsprojekte”.

Die lesse wat die regering uit die ses jaar van loodsprojekte geleer het, som hy in ’n voorlegging op:
“Daar is ernstige ongelykhede in toegang tot gesondheidsorg.”
“Dié ongelykhede word vererger deur die vermoë van die openbare sektor, byvoorbeeld ’n gebrek aan hulpbronne, toerusting en medisyne.”
“Die belangrikste is toegang tot sleutel-gesondheidspraktisyns.”

Prof. Alex van den Heever, gesondheidsekonoom verbonde aan die Universiteit van die Witwatersrand, sê die loodsprojekte het “klaaglik misluk”.

“Dit is duidelik dat die departement moes rondskarrel om projekte te vind om met geld van die NGV te finansier,” sê hy. Oudits van die gesondheidsombud strook met Van den Heever se waarneming.

In die ombud se jongste verslag sê hy daar was nie ’n beduidende verskil in die gehalte van die gesondheidsfasiliteite wat deel was van die NGV-loodsprojekte en gehalte van die gesondheidsfasiliteite wat deel was van die NGV loodsprojekte en ander nie.

“Die laagste prestasie-telling vir ’n NGV-proefdistrik was 42% vir die Vhembe-distrik, terwyl die hoogste vir die Tshwane-distrik op 70% was. Vier NGV-proefdistrikte se telling was minder as 50%, wat beteken dat hulle nie aan die nasionale norme en standaarde vir goeie gesondheidsorg voldoen nie,” lui die verslag.

Pillay sê die ombud se verslag is ’n “verkeerde maatstaf” vir hoe doeltreffend die NGV-loodsprojekte was. 

“Onafhanklike evaluerings het getoon daar was beslis ’n verbetering.”
Pillay sê die NGV-projek het nié ontspoor soos kritici sê nie.

Motsoaledi het in Julie verlede jaar deur ’n proklamasie in die Staatskoerant sewe ministeriële advieskomitees gestig wat hom moet help om die NGV te ontwerp.

Pillay bevestig dat nie een van dié komitees gestig is voordat Motsoaledi die wetsontwerp gepubliseer het nie. “Die minister het besluit om eers kommentaar oor die wetsontwerp te kry.”

* Lees ook hier.

Peperduur loodsprojekte waarmee die regering wou wys sy nasionale gesondheidsversekering (NGV) kan werk, het ineengestort binne maande nadat die bestuur daarvan aan provinsies oorgedra is.
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