A duty of CARE

A global spotlight is being shone on healthcare capabilities and facilities the world over. Beyond this renewed attention, it is also constitutionally mandated that the people of South Africa are provided with a minimum level of care.

LESEDI

The primary healthcare facilities in Lesedi Local Municipality are clustered in urban and service centres, while the rural areas are served through mobile units. Primary healthcare is rendered by Gauteng Provincial Health. There are two hospitals in the municipal area, namely the Heidelberg District Hospital, which is a provincial hospital, and the Suikerbosrand Clinic, which is privately owned.

The following are the primary healthcare facilities available in Lesedi Local Municipality, and are run by the municipality, unless otherwise specified: • Rensburg • Ueckerman Street (Gauteng

Provincial Government) • Ratanda Ext 7 • Jameson Park • Usizolwethu Devon/Impumelelo (Gauteng Provincial Government) • Vischkuil • Extension 23 Clinic • 3 x mobile clinics (Gauteng

Provincial Government) • Ratanda Clinic.

Early childhood development

Beyond primary healthcare, other healthrelated matters are of key importance in improving socio-economic outcomes. The leadership of Lesedi Local Municipality and Hollard Trust have committed to partner in developing a strategy for early childhood development (ECD) in the municipality. The aim of the strategy is to improve access to and the quality of ECD services to children in the area.

The quality of life of children up to five years old will be improved through implementing the Kago-Ya-Bana and SmartStart model for ECD. The ECD project will be rolled out in two phases – the diagnostic phase and the implementation phase. Upon completion of the diagnostic phase, the strategic framework for the implementation phase was developed. The ECD Strategic Plan will be implemented over a three-year period.

According to an audit report compiled by Hollard Trust, there are about 4 100 children across Lesedi that have access

to ECD services. However, there are about 7 700 children that do not have access. Various other challenges were highlighted in the report, such as: a lack of formal training for ECD practitioners; a highly unfavourable practitioner to child ratio; a lack of compliance in terms of registration; a severe lack of funding for ECD centres; a lack of infrastructure; and a lack of compliance with infrastructure and ECD programme requirements.

Lesedi Local Municipality also runs a day care centre where children up to the age of six who are not attending formal schooling are accommodated. The programme operates every day and the children return to their families in the afternoon. Three balanced meals are provided per day.

Community day care centre for the elderly

It is not only our children who are vulnerable and need looking after, but also the elderly members of society. Lesedi’s community day care centre for the elderly is used as a service point where provision is made for social, recreation and healthrelated activities in a protective setting for individuals who cannot be left alone during the day due to health and others social needs.

The Department of Social Development’s main mandate is to deal effectively with the plight of older persons by concentrating holistically on their welfare. The department looks into the formulation of policy, funding for such centres and all the activities revolving around elderly persons. Policy implementation and services rendered for older persons is a cross-cutting function and the responsibility of all departments.

EMFULENI

Primary healthcare services are currently being rendered by Emfuleni Local Municipality on behalf of the Gauteng

Department of Health. The services are being rendered as depicted below. The municipality renders comprehensive primary healthcare service to the community living within its municipal bounds and also ensures that its people have access to personal health services through promotion, prevention, curing and rehabilitation.

Emfuleni Local Municipality renders these services through 18 fixed clinics, of which five are structurally adequate to render a comprehensive primary healthcare core service package. The remaining 13 clinics have structural constraints that prevent comprehensive primary healthcare service delivery or one-stop-shop services as advocated by the National Health Norms and Standards.

Improving primary healthcare

In order to improve primary healthcare in this area, the Gauteng Department of Health is involved in a process aimed at ‘provincialising’ these services. Through this process, it is envisaged that all local clinics would be able to render services meeting the standards of the proposed National Health Insurance, which national government has currently slated for implementation in 2026.

Overcrowding, long queues and compromised infection control become a reality at these facilities. This is due to the challenges alluded to above. The Department of Health has prioritised the upgrading of health facilities to address the structural constraints in health facilities in this area. There is a general concern from the members of public that most of the clinics need to be upgraded and that their working hours be extended to accommodate all patients. There are generally long queues and a shortage of nursing staff in most of those clinics.

In order to help improve levels of care for patients and grow the professional skills of its healthcare workers, Emfuleni Local Municipality has a service-level agreement with the Gauteng Provincial Department of Health wherein the latter provides short courses to the municipality’s primary healthcare staff members.

Primary healthcare facility breakdown

The following number of public and private health facilities have been established within the municipal area of jurisdiction: • public hospitals – 4 • public clinics – 26 • private hospitals – 7 • private clinics – 4. Clinics are located in all the major settlements of Emfuleni, including Sebokeng, Evaton, Roshnee, Sharpeville, Vanderbijlpark and Vereeniging. Most of these clinics are capable of providing comprehensive primary healthcare services.

The hospitals are located within Sebokeng, Vanderbijlpark and Vereeniging. Many of these hospitals are located within the central business districts of these settlements. The distribution of these facilities places them in accessible locations throughout Emfuleni.

The Gauteng Provincial Department of Health is responsible for all public hospitals, while the Provincial Department of Health and Emfuleni Local Municipality share the responsibility for clinics and community health centres within the municipal area.

There are two major public hospitals in Emfuleni: the Kopanong Hospital located in Vereeniging, and the Sebokeng Hospital located in Sebokeng. The Sebokeng Hospital does not attend to the primary day-today care of patients, while the Kopanong Hospital provides exactly these services to patients.

As concerns healthcare on a more social level, developments have been undertaken to make progress in this sphere. Two early childhood development (ECD) prototype centres were launched and opened in April

2019 by the former Gauteng MEC for Health and Social Development. These facilities, located in Evaton West and Bophelong, accommodate both older persons and children, and operate as day care centres.

MIDVAAL

South Africa’s National Health Act (No. 61 of 2003) gives guidance and definition to provincial healthcare and municipal health services (MHS). It provides decentralisation and legal structures for the operation of the district health system. In accordance with the Act, Midvaal renders the provision of primary healthcare services on an agency basis.

There are no public or private hospitals in the Midvaal municipal area. Medical care is offered by three public clinics – namely in Meyerton, Randvaal and Kookrus – four mobile clinics, and various private facilities.

High-quality daily care is accessible to all people visiting the public facilities, where healthcare workers aim to work efficiently to optimise the scarce resources available.

Achieving priority goals

Within the municipality, there are three healthcare service delivery priorities that are recognised where strong progress has been made. These are: • Elimination of mother-to-child transmission of HIV/AIDS – this form of transmission is being reduced in the health facilities. • Effective treatment of chronic patients by transforming their lives – this results in increased lifespan, and there are fewer defaulters with more patients retained under care. • Provision of outreach health services to households – such services are key,

especially in communities that are suffering from poverty, and are provided through mobile units and door-to-door visits. Further, the following measures have been identified and taken to improve the performance of the primary healthcare system: 1.Good team spirit among health workers. 2.Provision of health education activities in the facilities. 3.Support from senior managers. 4.Monitoring and evaluation by clinic managers. As concerns further developments on the infrastructure side of the equation, the Memorandum of Understanding with the Gauteng Provincial Government gave directives for capital projects to be carried out by the provincial sphere of government; therefore, no capital projects were undertaken by the municipality in the last two financial years.

Health inspection

The Constitution of the Republic of South Africa defines the provision of MHS (nonpersonal health) as a function of local government in terms of Schedule 4 B. Section 84 of the Municipal Structures Act (No. 117 of 1998) further determines that districts must render MHS for the district as a whole.

The Sedibeng District Municipality resolved to render MHS on an agency basis through a service-level agreement with the respective local municipalities within its area of jurisdiction as from 1 July 2004. Given that MHS is currently either regarded as the same as or part of environmental health services, the World Health Organization perceives environmental health as addressing: “all the physical, chemical and biological factors external to a person and all the related factors impacting behaviours”. Thus, MHS also means the assessment, monitoring, correction, control and prevention of environmental health factors that can adversely affect human health.

The nine elements of MHS as listed in the National Health Act are core functions of the Environmental Health Section and thus form part of its daily routine. The Environmental Health Section is operationally funded by the Sedibeng District Municipality to the amount of R3 081 089. All statistics on the various environmental health elements are compiled in monthly and quarterly reports to the district and local municipalities.