Who we are:

1. Eastern Cape Health Crisis Action Coalition presentation to the parliamentary portfolio committee for health: 6 November 2013

2. Who we are: • Association of Concerned Specialists of the PE Hospital Complex • Black Sash • Budget Expenditure Monitoring Forum (BEMF) • Counsel for the Advancement of the South African Constitution • Democracy from Below • Democratic Nursing Organisationof South Africa (DENOSA) • Hospersa • Igazi Foundation • Jubilee • Junior Doctors Association of South Africa (JuDASA) • Keiskamma Trust • People’s Health Movement (PHM) • Professional Association of Clinical Associates in South Africa (PACASA) • Public Service Accountability Monitor (PSAM) • Rural Doctors Association of South Africa (RuDASA) • Rural Health Advocacy Project (RHAP) • Rural Rehabilitation South Africa (RuReSA) • SECTION27 • Sonke Gender Justice • South African Medical Association (SAMA) • Treatment Action Campaign (TAC) • World AIDS Campaign

3. Where is the Crisis? • Not just OR Tambo – Across the whole province. We have collected over 120 statements related to facilities in every district, EG: • Madwaleni Hospital • Hamburg Clinic • Town clinic in Port Alfred • Frere Hospital • Community health care workers across the province

4. A recovery plan alone is not enough • Long history of failed “turn around” strategies • Pattern of denialism and combative behavior from the MEC • ECDoH has instilled a culture of fear in employees rather than encouraging honesty • Intimidation of workers speaking out as part of the movement • Our evidence shows that equipment promised by Minister is not currently in facilities in OR Tambo • We do not know what happened, but we know it is not in the facilities • We need long-term thinking and planning rather than short-term reactions (although long-term planning includes meeting of immediate needs)

5. History of a lack of planning and budgeting • We now need a PROVINCE wide, comprehensive plan that includes: • Timeframes • Milestones • Measurable indicators • Budget • Must include ALL stakeholders (Provincial Treasury, Premier …) • Legal presentation to follow on what the Constitution requires of a plan

6. Recommendations • Premier, Provincial Treasury and ECDoH to be called before committee to discuss their roles • Identify emergency issues, such as EMS and availability of essential medication, and implement immediate measures to address them • ECDoH “plan” to be interrogated and ECDoH to be required to table a proper plan • We draw attention to our response, which is in your packets • We will develop and submit a framework for the plan, which we will be happy to share

7. Crisis and HRH • Key DoH policies, such as NHI and PHC, require sufficient, competent, equipped, caring and valued HRH on the ground • Vacancy rates, frozen posts, resignations well known • More needed than “correct and punctual payment”!!! >> Key HRH issues affecting health care delivery in EC HRH Management • Lack of infrastructure and management capacity at all levels of the health care system • Poor implementation of HRH policies • Acting positions lead to inability to make decisions

8. Recruitment Despite some improvements in HR processes, the following issues still prevail: • Poor reputation of ECDoHin terms of payment of salaries and poor management repels doctors to come and work here • Lack of essential equipment such as computers leading to delays in processing appointment letters. • Bottlenecks in the administrative processes of recruitment such as the requirement of multiple signatories for approval of a placement into a funded vacant post • Lack of funding for vacant posts

9. Retention Key issues affecting retention in the EC (retention survey, 2013): • Work culture– disrespect, favoritism, nepotism, negative attitude, gossiping, lack of professionalism, lack of support, no consultation on decisions by management, management does not listen, unfair handling by management of certain issues, lack of clear goals and vision. • Learning and development opportunities– Lack of skills development on the job as well as career progression, OSD blocking possibilities for promotion, no focus on personal development, no opportunities to study further. • Leadership - Leadership needs to create the environment for engaged employees to thrive in . Problems identified: lack of order and discipline in the running of department by managers , lack of leadership and managerial skills by some, management – inconsistency, managers being dishonest and disrespectful to other employees, management’s failure to see the outcome or productivity made by certain departments, divide and rule leadership, poor, bad management, failure by management to address employees issues, lack of leadership , management’s inability to make decisions about daily running of health facilities and attitude of management. • Non-financial recognition– Lack of recognition and acknowledgement from leaders, managers and colleagues to individuals leading to de-motivation of staff. • Communication- There is concern among Health Workers regarding both formal and informal communication: Barriers to effective communication, the channels and protocol for communication are not observed, improper communication procedures, poor interaction with management and a lack of communication between staff and managers. > National HRH Plan and Chapter 8 “Access in rural and remote areas”. What is the EC Plan for equitable distribution, recruitment and retention of HRH?

10. Constitutional requirements • The Constitution requires that a plan to fix the healthcare system in the Province and fulfil constitutional rights must be reasonable.

11. The reasonableness of the plan may be assessed by criteria that include the following: • It must be reasonably conceived and implemented. • It must be capable of facilitating the realisation of the right. • It must be comprehensive and coherent. • It must be coordinated in terms of Chapter 3 of the Constitution. This means it must be determined by all spheres of government in consultation and that each sphere must accept responsibility for the implementation of particular parts of the plan. • Appropriate financial and human resources must be made available for the programme. Budgeting duties apply to national, provincial and municipal governments in appropriate circumstances.

12. It must be balanced and flexible and make appropriate provision for short-, medium- and long-term needs. • It must be transparent, and its contents must be made known effectively to the public. • It must make rights more accessible to a larger number and wider range of people as time progresses. • It must make short-term provision for those whose needs are urgent and who are living in intolerable conditions. • It must be conceived of with an appropriate understanding of constitutional and statutory obligations.

13. General concerns with the ECDoH plan in the light of constitutional requirements • The lack of timeframes, indicators and “monitoring and evaluation” • The need for short- medium- and long-term interventions • The need for clarity on the status of the document • No prioritising of service delivery

14. National intervention • More detailed intervention plan welcomed – contains timeframes, firm commitments and budget. Partly evidence based. • Focused on ORT (for obvious reasons) • Need for more cooperation between national and ECDoH

15. ENDS THANK YOU