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The Community Health Workers System is Crumbling.

Written by David.

South Africa’s community based health workers are in crisis. The problem is no mystery either.

Currently 72,000 health workers actively work in communities across South Africa. Though this might sound fantastic, it is far from it. The system has no structure and no set guidelines to co-ordinate its work. Instead of making that vital connection between the healthcare system and the people who need it most, it is sending mixed messages and lost signals.

This system is not flawed and destined to fail it has worked to brilliant effect in places such as Brazil. The problem lies with National Government and the Health Department not controlling the community healthcare provider system.

There is no formal structure the provinces are left to do pretty much whatever they see fit for the system.

We implore you to download the full Mail&Guardian article written by Mia Malan and read it for yourself.

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Sebokeng Hospital warned to shape up

Written by .

Gauteng’s public healthcare institutions have been warned to shape up or face the wrath of authorities. This came after Gauteng Premier David Makhura paid a surprise visit to Sebokeng regional hospital in the Vaal on Monday.  Upon inspecting the facility, Premier Makhura said the hospital was in need of an overhaul.

“The hospital has very old infrastructure, staffing backlogs and the filing system needs to be upgraded. The hospital services about 500 000 residents from Emfuleni, Sedibeng, Orange Farm, Heidelberg with patients coming as far as Sasolburg in the Free State. 

“Though the hospital has very serious challenges it is very encouraging to see that the staff here are committed to giving the community the best service possible. Shortening patient queues is very important and this hospital is doing very well in this regard. It is very encouraging,” Premier Makhura said.

During the unannounced visit, the Premier was accompanied by the Gauteng MEC for Health Qedani Mahlangu.  MEC Mahlangu said her department was currently working with the Departments of Infrastructure Development and Finance to investigate an alternative method of funding in order to build additional infrastructure.

“The modernisation of the filing system should be completed by the end of this financial year,” MEC Mahlangu said.  Hospital CEO Zolela Ncwabe said the number of patients that they cater for is that equalling the entire province of the Northern Cape.

“With the resources we have, we try to go the extra mile but we’ve requested that the Health Department explore the use of the electronic filing system which would ease filing at the hospital and assist with staffing," she said.


In-Depth Report: Mpumalanga Health deadly debt

Written by Health-e News.

A closer look at the shocking facts about the state of public healthcare in Mpumalanga.......

Why is the health of a province not more newsworthy than a bunch of people dressed in red? This needs to make front page news.

In-Depth Report: Mpumalanga’s deadly debt
Thousands face disability as orthopaedic services collapse
Emergency medical services leave patients stranded
National Health Insurance pilot district “shows signs of collapse”
Medicines go missing in Mpumalanga
Tensions flare over poor service delivery in Mpumalanga


Patient safety advisory for all Mpumalanga government hospitals - Health Department "under curatorship"

Written by With comments by Vicki Pinkney-Atkinson.

Report by the SA Government News Agency 24 June 2014 second edition.
(Click here to see the press release.)
Editorial comments by Dr Vicki Pinkney-Atkinson, PHANGO, former Vice Chair of the Gauteng Government Facility Accreditation Project


The Mpumalanga Health Department been placed under curatorship from 21 June 2014 as the provincial health system is in dire straits. The curator will be tasked with ensuring the provision of food, linen and waste management in all the provincial hospitals urgently. (Editor. Questions citizens should be asking. What does curatorship mean in this context? Who is in charge of health in the province? Is this financial curatorship or something else or both?)

Zibonele Mncwango, the spokesperson for Mpumalanga Premier David Mabuza, said the treasurer and the Office of the Premier will now carry out the process of appointing a curator meant to improve health service delivery in the 33 Mpumalanga government hospitals. “The intervention is meant to improve the situation in the health system and once the situation is back to normal, the curator will be removed.” (Editor. Questions that citizens should be asking. If it is the Mpumalanga Department of Health, then why are the hospitals only being targeted? It sounds like a health system wide failure. How wide is the crisis in district clinics in Mpumalanga?)


Meanwhile, Premier Mabuza called on hospital CEOs to commit to work hand-in-hand with him and the curator in turning around the situation. (Editor. Questions that citizens should be asking. If the curator has not been appointed yet what happens until then?) Premier Mabuza made the call on Monday during a meeting with CEOs of all the provincial hospitals. The meeting aimed to deal with severe mismanagement and other challenges perceived to be threatening the lives of the patients. (Editor. Questions that citizens should be asking. Is this a perception as implied in the news release, or is it the reality? Read the list below.)

During the meeting, where the Premier spent over five hours interacting with the CEOs of all 33 provincial hospitals, Mabuza received verbal reports from CEOs of their challenges. The information painted a negative picture in terms of infrastructure, human resources, leadership and contract management in the health system. The list below is what CEOs reported according to Many of these are issues that the National Department of Health Office of Health Standards Compliance and it governing board should be reporting to the public as a matter of urgency. Transparency is needed for the citizens of Mpumalanga.

  • All hospitals had infrastructure problems which were broad ranging with the following examples:
  • ageing and dilapidated buildings
  • dysfunctional boilers and laundry machines
  • lack of life saving equipment
  • leaking roofs
  • lack of accommodation (EditorQuestions that citizens should be asking: Doese this mean bed for sick people? How does this affect the safe delivery of babies and their mothers?)
  • Surgical procedurers
  • insufficient budgets for operations
  • lack of theatre tables
  • Basic human needs
  • Serious water shortages at some hospitals  -(Editor. Questions that citizens should be asking. How does this impact the control of leathal hospital aquired infections? Why are the hospitals without water not being shut down with immediate effect?)
  • Running out of groceries - (Editor. Questions that citizens should be asking. Is this a euphemism for no food? Does this mean that patients are not getting food? Should relatives bring food in? This needs clarification.)
  • Linen for beds and for operations -linen istaken and cleaned at faraway hospitals with equipment (Editor. Questions citizens should be asking. What happens if there is no linen delivery? Are patients to bring their own linen and get it washed? Does dirty and contaminated linen stay on the beds as a source of infection? Where are the piles of dirty linen stored?)
  • Financial issues
  • Non-payment of some suppliers (Editor. Questions citizens should be asking. Is this like the Gauteng Government's failure to pay suppliers? If yes, how long is the list, what do they supply and how long have they been waiting for payment? Are the food suppliers on this list?)
  • No budgets for surgical procedures
  • Human resources
  • CEOs also complained that many of them were employed in an acting capacity (Editor. Questions citizens should be asking. How many CEO are in an acting capacity and what is the holdup?)
  • Workmanship at the hospitals was also a challenge
  • And last but not least patient safety was compromised as there was inadequate fencing.

Patient safety severely compromised

Editor: It would appear that patient safety is seriously compromised by all of the above, least of all by the lack of fencing! Questions citizens should be asking. How does this match the South African Patients' Rights Charter which the government supports?

"A healthy and safe environment
Everyone has the right to a healthy and safe environment that will ensure their physical and mental health or well-being, including adequate water supply, sanitation and waste disposal as well as protection from all forms of environmental danger, such as pollution, ecological degradation or infectio

In response, Premier Mabuza acknowledged that the situation needed urgent attention. “We are going to rework their entire budget structures. We must further intervene with immediate effect in terms of infrastructure. Every hospital must be given a minimum number of people in order to be functional. (Editor. Questions that citizens should ask. Were these budgets approved? Has the money for hospitals been diverted to other provincial line items? How much has is due to wasteful or corrupt expenditure or inappropriate district administration costs?)

“As the provincial government, we will work on some powers which we think should be delegated to the CEOs. However, they must not abuse them. We want to ensure that they get certain delegations and they must be able to handle the finances,” said Premier Mabuza. He said provincial government would to ensure that systems at the hospitals were strengthened. The premier further urged the CEOs to manage the hospital as expected to ensure that health system was not collapsing. (Editor. Questions citizens should be asking. Does the Premier actually mean "collapsED"?)

Editor. Suggested additional reading is the District Health Barometer 2013 (Published by Health Systems Trust Click here to download.) This report suggests a budgeting problem in the three Mpumalanga districts with

  • District hospitals having decreased budgets over time
  • Primary health care budgets inadequate from the beginning and still below the national average
  • District administration being above the national average.


Has your clinic or hospital run out of medicine? A quick way to report & get action

Written by Vicki Pinkney-Atkinson.

Medicine stock outs can be life-threatening

Patients are you gatvol when you go to the clinic and there are no medicines or equipment (syringes, stoma bags, oxygen)? No or too few of your prescribed medicines is called a “stock out” in medicalese.

Other forms of stock outs are when:

  • You are turned away from your clinic and referred elsewhere
  • You’ve been given an insufficient supply of medication
  • Your treatment was changed because the medicine you usually take isn’t available

Make your voice heard by contacting the STOP STOCK OUTS PROJECT

NO NAMES NEEDED only the out of stock medicine and the clinic or hospital name.

Health care workers are you frustrated when you turn patients away?

You can help to monitor stock outs at your facility by signing up to be an anonymous sentinel surveyor. Your name will not be known. You will get a SMS or email each month to ask you to report on any stock outs or shortages at your facility.

Enrol now:

· Go to

The Stop Stock Outs Project (SSP) is an independent civil society consortium that monitors availability of essential medicines in public sector facilities across South Africa.

For many years SSP consortium members dealt with stock out reports on a makeshift basis, with patients and health care workers alike reporting medicine supply issues at their facilities. Patients experience the persistent plague of essential medication stock outs which may be life-threatening.

The consortium members combined efforts together as civil society’s response to the chronic shortages and stock outs of essential medicines across the South Africa. And so the SSP was born. It very practically helps patients in their thousands.

Don’t delay report any essential medicine shortages or stock outs at any government run clinic or hospital. When you contact the SSP to report a stock out/shortage the information is documented. A case is opened to track the stock out from the time it was reported until the stock out/shortage is resolved and the medicine is available again at the facility. Confidentiality is ensured. Even better, you can track the progress of your report on the website. That is an A+ for transparency.

Watchdog for essential medicines supply

As a “watchdog” the SSP communicates with the right people: the provincial and national departments of health and other stakeholders such as drug companies. It makes sure that shortages and stock outs are responded to and resolved ASAP. By reporting and investigating stock outs and shortages, the causes of supply chain breakdowns are identified and steps are taken to strengthen and improve the system going forward.

PHANGO & The SA NCD Alliance are working with SSP to make the noncommunicable diseases reporting more effective.

The consortium of these well respected organisations:

  • Medicins San Frontieres
  • The Rural Doctors Association of Southern Africa
  • The Rural Health Advocacy Project
  • The Southern African HIV Clinicians Society
  • Treatment Action Campaign



Medicines & Related Substance Bill tabled

Written by Vicki Pinkney-Atkinson.


Click here to download


NHI First 18 months DOH report

Written by Vicki Pinkney-Atkinson.

Hot off the press booklet on NHI published by the Department of Health and presented to the select committee in April 2013




Patient-centred standards - says who?

Written by Vicki Pinkney-Atkinson.

New publication by the National Department of Health Fast Track to Quality:The Six Most Critical Areas for Patient-Centered Care

PHANGO congratulates the National Department of Health on this publication. It is a step forward in making the patients the centre of care. The document links the first three national core standards with patient-centredness and then specifies the following as priority focus areas:

1. Caring staff and the feeling of being cared for

2. Cleanliness of facilities

3. Waiting times to receive care

4. Safety from accidental harm or medical errors

5. The risk of being infected

All six are important hence the congratulations but one wonders the extent to which patients and patient groups were consulted in the development of the criteria and the finalising of the document.  The degree to which these are patient-centered is hard to gauge as the sources are “the concerns and complaints raised by our patients, the results of surveys that have been carried out, and reports in the media” (p. 4 above document.

The document appears to be written from the perspective of a health care worker/professional. PHANGO uses the International Alliance of Patients’ Organisations (IAPO) definition of patient-centred health which highlights five principles and we have highlighted our findings:

  1. Respect covered
  2. Choice and empowerment – empowerment covered to some extent but not choice
  3. Patient involvement in health policy - not covered in this document
  4. Access and support access covered, support scantily covered
  5. Information – poorly covered with only two on page 6 about information to patients in a study and on discharge which leaves a lot of information

PHANGO invites your This e-mail address is being protected from spambots. You need JavaScript enabled to view it


National Core Standards NDoH

Written by Vicki Pinkney-Atkinson.

Published by the National Department of Health Abridged Version 2011 is subtitled Towards Quality Care for Patients, It is a must read for patients and patient groups.
It lays out 7 domains of core standards:

  1. Patient Rights based on Patient Health Charter and Batho Pele
  2. Patient Safety, clinical governance and clinical care
  3. Clinical support services
  4. Public Health
  5. Leadership and Governance
  6. Operational Management
  7. Facilities and Infrastructure.

To download a full copy of the report click here icon NATIONAL CORE STANDARDS 2011 (801.22 kB)



NHI- universal health coverage page

Written by Administrator.

PHANGO supports the access to health services for all as laid out in Section 27 of South African Constitution which states that: "Everyone has the right to have access to health care services, including reproductive health care; [and that] no one may be refused emergency medical treatment". The path to universal health coverage is laid out in the Department of Health’s National Health Insurance (NHI) Green Page and related documents. PHANGO reports on publications, activities and debates for its members.


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