Eastern Cape COVID-19 Interventions; Alcohol Impact on Health Services; with Ministry

Meeting report

Opening remarks by the Chairperson
Co-Chairperson Dhlomo opened the meeting. 

He said that two Ministers were in quarantine after contracting COVID-19. They were the Minister of Employment and Labour, Mr Thulas Nxesi, and the Minister of Mineral Resources and Energy, Mr Gwede Mantashe. He said that many relatives, friends and colleagues were also unwell. The staff members in hospitals and clinics were doing an excellent job in the fight against COVID-19. He asked everyone in attendance to hold a moment of silence for these people. 

He asked for apologies and attendance. 

Co-Chairperson Gillion asked for an indication of Members present from the Committee secretaries. 

The Secretary of the Select Committee on Health and Social Services, Ms Marcelle Williams, indicated that there had been no apologies received from the Committee. 

The Secretary of the Portfolio Committee on Health, Vuyokazi Majalamba, said that Mr A Shaik Emam (NFP) had apologised. 

Co-Chairperson Gillion asked for confirmation of attendance by the national and provincial Departments of Health. 

The head of the Eastern Cape COVID-19 task team, Dr Sibongile Zungu, introduced herself. She had been posted from the Department of Health to the Eastern Cape Project Management Unit (PMU).  

Co-Chairperson Gillion asked for an indication of Members from the provincial Department of Health. 

The Member of the Executive Council (MEC) for Health, Eastern Cape, Ms Sindiswa Gomba, said the technicians were struggling to connect other Members. 

Co-Chairperson Dhlomo requested that the agenda be accepted as it was. The meeting was moving to item five on the agenda. 

He had received a letter the previous day written to the House Chairperson, requesting changes to the meeting agenda. Changing of the agenda after the agenda had been sent out was against the rules. He concurred with the Minister of Health, Dr Zweli Mkhize. 

Dr Gomba had said Dr Mkhize would try to log in to the meeting while he was travelling. 

The PMU office supporting the Eastern Cape was led by Dr Zungu. There were challenges in South African related to COVID-19. The Eastern Cape was one such challenge. A decision taken three weeks prior to the meeting had been shared with the Premier of the Eastern Cape and Minister Mkhize to beef up leadership of the Eastern Cape Department of Health with a team led by Dr Zungu. The meeting provided an opportunity for the Committees to hear what was being done to address the Eastern Cape challenges. He hoped it would guide the Committees on the turnaround plan regarding the issues. He specifically identified that there were gaps on matters related to field hospitals in the province. 

MEC Gomba said that she would not waste time. It was correct that interventions had been made at the province level. These interventions had led to implementation of a project team led by Dr Zungu, who would provide detail of the interventions in the presentation. 

Eastern Cape COVID-19 Interventions 
Dr Zungu introduced her colleagues from the PMU. Dr Zungu handled the clinical / healthcare matters of the responses. 

The team had the resources to work with in the province, on the financial side, as well as collaboration with other stakeholders such as disaster medicine. The PMU was in contact with a disaster medicine specialist. It was also receiving resources from the World Health Organisation (WHO), TBHIV Care, Right to Care, and GIZ assisting districts in the province. 

Co-Chairperson Dhlomo welcomed Minister Mkhize to the meeting. 

He told Dr Zungu that she was presenting to the National Assembly and National Council of Provinces; it was a joint committee meeting.

Minister Mkhize greeted the MEC, provincial representatives and the Committees. He said he wished to be part of the discussion. He had seen significant challenges from Eastern Cape in the past weeks and had taken the view of giving significant support to provincial government. This decision had involved discussions with the MEC, the Head of Department and himself. 

The team led by Dr Zungu would provide analysis of challenges in the province. Minister Mkhize would oversee all challenges; this was the outcome of an agreement with the Premier and the MEC of the Eastern Cape. 

There were issues of shortages of staff, oxygen, equipment and quality of care; the Eastern Cape required assistance. 

The MEC would follow on from the presentation made by Dr Zungu. 

Dr Zungu appreciated the Committees’ oversight and interest in solving the challenges in the Eastern Cape. 

The Deputy Minister of Health, Dr Joe Phaahla, was also present. 

Dr Zungu began the presentation. She said the PMU operations had been undertaken in a “military response”. 

Epidemiology and Projected Cases 
The PMU co-presenter said, on the epidemiological impact on health system, that the PMU was reviewing the definition of the National Department of Health. 

Bed Descriptors 
Quarantine beds were those available to people who did not test positive for COVID-19 but were still required to quarantine themselves based on guidelines. 

Isolation beds were those for patients that had potentially tested positive with no or mild symptoms and were unable to isolate themselves at home. General hospital beds for COVID-19 patients were for patients who tested positive with mild to moderate symptoms and required supportive treatment such as oxygen. 

Critical care beds for COVID-19 patients were those capable of providing major systems support which included respiratory support and clinical monitoring. These were supported by clinical expertise, support systems and equipment. These beds included current forms of intensive and high care beds, and temporary facilities designated for critical care. 

Palliative or end of life beds were those capable of providing end of life care for patients, including supportive care and comfort measures. This care would include oxygen administration for reduced discomfort and pharmaceutical measures for comfort. 

Eastern Cape COVID-19 Statistics 
As of 17 July 2020, the total case number was 58 860. The previous day’s tally was 66 759 cases. This was 17% of national cases; which was consistent. Metros made up the majority of cases in the Eastern Cape. There was a concern that more remote districts of the Eastern Cape were substantively affected by COVID-19. Planned interventions of the Eastern Cape included scaling of activities in all districts. 

The National Modelling Consortium breakdown of revised modelling data had been used in examining the Eastern Cape to advise on preparation of facilities in the province. The anticipated peak incidences of COVID-19 had been identified using data of symptomatic cases. However, 55% of cases did not have symptoms and went undiagnosed. There was a representation of the median projected peak rising to 90 000 cases in August 2020. Hospitalisation showed a spread of the peak lasting between August 2020 and September 2020 due to delays in the onset of severe symptoms. This was representative of the duration of patients’ stays in hospital. 

There was anticipation of 9 000 deaths in the province categorised as unavoidable deaths. These would be occurring despite interventions and related to the nature of the disease. The concern was of not increasing capacity in the Eastern Cape; then the number would exceed 9 000. 

The marginal deficit of general ward beds represented districts in colours that described the expected experiences of the peak of each district. Nelson Mandela Bay metro’s escalation had been seen in July 2020. It had been indicated to provincial colleagues that OR Tambo would be the next to peak with delays into September 2020. 

Additional capacity had been added through the VW field hospital. 

Significant surge capacity needed to be increased to meet the demand of critical care capacity. More remote districts did not have critical care beds capacity or registered ICU capacity. Therefore, these locations routinely referred patients to metros. This resulted in a substantive deficit in critical care capacity even when combining public and private capacity. 

There had been collaboration with VW to build Phase 2(a) with critical care beds and oxygen beds on top of already available beds. The Eastern Cape was, however, likely to need another field hospital or to increase capacity in Buffalo City due to referral re-routing to the facility. 

Actions were required that were being addressed with the National Executive Committee (NEC) and the Department of Health; there was an emphasis on a sustained effort to improve strategic information in the province, supported by the WHO and Right to Care. The PMU was also strengthening the existing strategic information team. 

Command and Control System in the Pandemic Response
Dr Zungu said the province had responded to COVID-19 by creating a response structure; the PMU team had come in to strengthen with the command and control structure for agility. This functioned at provincial, district and facility level. 

Actions required for the gold command structure included the creation of an incident management space that was supported by strategic information infrastructure. There would be revision of the provincial command structure to implement the principles of the incident management team according to WHO guidelines. It would also implement the command and control of the systemic response at lower levels. 

Actions required at silver command were similar to gold command. This was disseminated at district level, or clustered at regional level. The command involved empowering district managers to understand the epidemiology of the pandemic. There had been good interactions at ward-based level. Actions required for bronze command included the implementation of the structure at hospitals and depots to ensure the management of the COVID-19 response and inter-facility coordination. 

Other general considerations were taking place in daily meetings. Managers at all levels were required to establish baseline data for understanding the number of beds set aside for COVID-19, the number of additional beds for surge capacity, and the number of beds derived from field hospitals. An information gathering system was required to be established. 

Service Delivery Model – Hub and Spokes 
Key aspects and choke points of the province and each district were established under the hub and spokes model in order to determine what was the most feasible way of rearranging the system for COVID-19 responses. This was in order to ensure that anyone requiring medical attention in any corner of the Eastern Cape was aided within a maximum of two hours. 

Factors to Consider in Developing the Hub and Spoke 
Factors included the strengthening of other facilities to form mini hubs to assist major facilities in not becoming strained. There was also the issue of travel times, distances, and road infrastructure to be taken into consideration. Some issues would be taken to national level, such as the proximity of some Eastern Cape facilities to other provinces to ensure equitable access to services. Emergency services should be able to move some patients to other provinces after these discussions. Recent facilities that were modern had been built to provide halfway capacity. 

There was realignment of emergency services bases to hospital infrastructure. In some cases, the location of the ambulance base created bottlenecks and were too far from the hospital to which patient would be referred. Therefore, ambulances were placed closer to the hospital and referring hospitals would have an ambulance on site for a quicker response. 

Development of Detailed Project Plans 
Facility specific interventions that were required had been taken in consultation with the MEC and labour stakeholders. The development of detailed project plans had been done. 

Broad actions had been recommended to increase the capacity to manage COVID-19 in the districts. 

Restoring health and safety standards in Livingstone and Dora Nginza Hospitals included issues of addressing fear of workers to be in COVID-19 environments, as well as general hospital management and capacity challenges. 

Facility Specific Interventions Required
Reverend Doctor Elizabeth Mamisa Chabua-Nxiweni Field Hospital (VW) had over 4 000 bed capacity if it was fully deployed. However, when running such a facility at such a large scale, operators faced complexities. These included challenges with infection control, deployment of resources and movement of staff. To limit risks, it may not be a good thing to have patients in quarantine, isolation and critical care all in one facility without ensuring there was a great measure of infection control implemented. 

Phase one was currently operational and equipped. Infection control issues were being taken care of through the implementation of safety areas. Resource allocation would be taken care of to reduce the transmission of infection. 

Phase two (a) was an area of the hospital that had oxygen facilities. It had not yet been built. The question was whether to build the entire facility with oxygen in a single part. Once increasing the number of oxygen beds to cover the entire facility; nursing requirements and increased staff would make this problematic. This was especially the case since COVID-19 patients required close supervision and monitoring. 

Actions Required 
A critical hurdle to overcome was to have the staff willing to do the work as well as the sufficient clinical expertise. It was suggested to make use of senior level students to provide support, as the nursing and clinical assistance staffing numbers needed to be revised to cope with expected patient levels in Phase Two of the facility. 

It was recommended to reduce the scope of the facility, with Phase two (a) enhancing the capability for Phase two beds to available with oxygen support. This would mean redirection of funds for expansion of the facility towards operationalising it. 

Oxygen Supply Chain Management 
Hospitals were faced with six to eight times more demand for oxygen than usual according to ‘Right to Care’ projections. 

Actions required were for the hub and spoke to inform capacity development for oxygen store and hospital reticulation investments. There was also to be consideration of sourcing oxygen in neighbouring provinces to service districts that were further from Nelson Mandela Bay. These included Alfred Nzo and OR Tambo districts, which could source oxygen from KwaZulu-Natal. 

Priority Focal Areas for the PMU 
The PMU focus areas were the ensuring of epidemiology and surveillance that were data driven. The PMU would also identify key areas requiring support in order to improve the COVID-19 hospital and district responses quickly. 

Dr Zungu concluded the presentation. 

Co-Chairperson Dhlomo thanked Dr Zungu for a detailed presentation. He opened for the floor for Members to ask questions. 

Discussion 
Ms E Wilson (DA) recounted that earlier, in 2020, when discussing budgets, the Committees had received the Auditor-General (AG) reports regarding performance of the Eastern Cape and national departments. These had been “absolutely damning”. They had shown abysmal financial and management performance. No action had been taken and there were no improvements. It became fast apparent as the presentation progressed that it was the same situation. Dr Zungu had spoken about preparing for the COVID-19 surge when it came; the horse had already bolted. The presentation had spoken about implementing more COVID-19 responses; what then had been done in the hard lockdown if matters were only being planned for in July 2020?

She noted that Eastern Cape had one ambulance per 21 000km. For the plan of moving people to districts and hospitals, she reckoned that the province lacked sufficient ambulances. 

The presentation had been speaking of fast-tracking oxygen supply in the coming months, yet everyone had known for certain from the first day of the outbreak that COVID-19 attacked the lungs; yet in the middle of the surge of a major crisis, the fast-tracking of oxygen supply was only being spoken of. 

Mr P Van Staden (FF+) reckoned that the Eastern Cape could reach 100 000 case by the following week. From the presentation, he could not see that the province was in any way prepared for this.

He had heard the plan of transferring patients from districts; he concurred with Ms Wilson, saying that there were not enough ambulances to do so. How would this be done? What was the timeframe for completion? People would die by the thousands in the province due to the lacking service delivery in the Eastern Cape. How would these plans be implemented?

Ms N Chirwa (EFF) said that the presentation was more frustrating than pleasing. The Committees were hearing of plans but not of implementation. The Committee wanted dates in order to exercise accountability. Dates were required for plans otherwise they would be considered as unimplemented. 

There had been a protest on 16 July 2020 by community healthcare workers who had been on contract work for over ten years. When would the community healthcare workers be permanently employed by the province? 

Minister Mkhize had employed people not long ago to compile recommendations for the province. What has the recommendations been? How far has the province gone in implementing the interventions of the National Department of Health?

She asked Minister Mkhize what it would take to lobby and move to implement Section 100 of the Constitution. There was no service delivery in the province – simply plans the Committees knew would never come to fruition. 

Ms H Ismail (DA) said that the presentation had spoken in the broad action recommendations to address staff shortages, other healthcare shortages and essential needs at health facilities; why has this not been dealt with at the start of lockdown? This had been the original intention of the lockdown – to prepare healthcare facilities. How would the province cope with COVID-19 without sufficient healthcare professionals? 

On the province being without sufficient health professionals, how many health professionals have tested positive for COVID-19? 

Dr P Dyantyi (ANC) said that as someone who had done oversight in the Eastern Cape, she wished to say to the PMU team that although many things had not been done, she had seen the improvement. This was particularly in districts that were more rural; this had been a concern of the oversight team. OR Tambo had 1.6 million people; it was the biggest metro in the Eastern Cape and had been severely lacking.

On the 9 000 unavoidable deaths, she had seen from other countries the strain that people got when having to bury loved ones. She asked for more detail on mortuaries. She knew that people did not want to speak of deaths, but deaths were rising and the peak was imminent. What preparations are being done in this regard?

She knew that provincial district hospitals did not have oxygen capabilities. She was happy it was being attended to. She asked for specific hospitals in districts already provided with oxygen. 

Ms S Gwarube (DA) said her colleagues had highlighted the disappointments from the presentation. She appreciated the work done by the team. There were still things to be done.

Questions remained around specific timelines. While Dr Zungu had been through in detail of what needed to be done and how there had been no timelines. What are the timelines for field hospitals in the province? She understood it currently there was one functioning field hospital operating at half capacity. How far are the other projects? 

On critical districts like Alfred Nzo not having critical care beds, she asked when the critical care beds would be seen. This involved taking services to the people. 

On oxygen supply, contract talks were still pending to augment oxygen supply. When would this be resolved? Again, these were critical services being taken to the people. 

On rural areas people being referred to metros; this would mean the metro facilities were overwhelmed. What are the timelines to see the critical care beds added to rural districts? Metro hospitals were over capacity in terms of staff and beds and oxygen supply. 
 
Dr K Jacobs (ANC) said it was clear there were challenges in the Eastern Cape. He appreciated that there had been intervention from the Ministry and the Department of Health. It was clear that it was at a late stage to try and save lives in the Eastern Cape.

To Dr Zungu and the PMU team, when speaking of the 50% capacity in terms of critical care beds and 65% capacity for general ward beds, he asked when this capacity would be higher. Deficits already existed at these percentages of need. 

The Eastern Cape had already been at the back end in terms of healthcare professionals prior to COVID-19. Infrastructure was being procured, but this still required a plan to find the necessary healthcare professionals to make use of the new infrastructure. Where will the health care professionals be found to increase capacity?

Ms D Christians (DA, Northern Cape) said that the Committees had all heard the horror stories of dysfunctional clinics, overwhelmed services and problems with ambulances. The meeting had been labelled as a national intervention to the province; how is this different from placing the province under strict national administration? This was with the purpose of saving lives and upholding the dignity of the Eastern Cape people. 

Mr T Munyai (ANC) said that his question was for the ministry. Is the ministry being paid by national or provincial government? 

He said that Dr Zungu had listed a number of agencies and partners in the presentation. These had been given as acronyms. He asked for the full names in order to know who was being spoken about. 

The detailed report of the Eastern Cape had been mentioned. This would indicate specific interventions. It would be appreciated if the report was shared with the Committees. 

Mr Munyai’s connection cut out; Chairperson Dhlomo asked Mr Munyai to submit his last question in writing.  

Mr M Sokatsha (ANC) said on demand in terms of hospital beds and capacity present, that the report had indicated less or no capacity at certain facilities. Given the shortages of ambulances, the report had indicated that patients would be transferred from one facility to another. He was not confident the problem could be solved in this manner due to shortages of ambulances. He wanted the facilities without the capacity to be beefed up. 

On issues of organisational considerations and arrangements, he asked if there were district managers in all the districts in the Eastern Cape. Were there CEOs in all the hospitals? Were these people qualified to manage hospitals? On the appointment of staff, the presentation had indicated that extra hands were needed. Did the province have the budget for this? 

Mr M Bara (DA, Gauteng) said that he would highlight the keys to success or failure of the Eastern Cape. One was the issue of scooters and the money that had been allocated to it. The second was the R4.8 million claimed by a public representative in the Eastern Cape in OR Tambo. This related to general theft that was on the rise. This was taking advantage of the opportunity provided by the fight against COVID-19. This issue was how to then deal with COVID-19 adequately if there were such issues on the rise with theft and people with selfish interests whilst they were entrusted to work for the betterment of the people of the Eastern Cape.

Co-Chairperson Gillion appreciated the presentation. She found it strange that certain Members had tried to play politics with the deadly disease. Not long before, the Joint Committee had the privilege of asking the Minister and Deputy Minister to give assistance to the people of the Western Cape when it was the epicentre of the spread of the virus. People had died and were still dying across the country. She urged Members of Parliament from both Houses to take the virus more seriously than using it as a political tool. 

Could the Minister and the team provide a timeframe of the intervention? When the Ministry and the National Department of Health had intervened in all provinces the results of the intervention could always be seen. It was a turnaround strategy to assist the province as had been done in other provinces.
 
The historical disadvantages of the Eastern Cape needed to be taken into consideration. 

She appreciated the presentation and the team taking the lives of all people seriously across the country. She wished to show her appreciation for the national department. The members were not present to play politics; they were there to save lives. 

Co-Chairperson Dhlomo handed back to Minister Mkhize for responses. The Minister could respond first, then Dr Zungu and the MEC.  

Responses
Minister Mkhize asked MEC Gomba to start with the responses. He said that the questions Members had asked were about what had been happening prior to lockdown. Other questions related to the MEC’s response were on beds being put in place, issues of staffing and ambulances. He said the Committee could then move to Dr Zungu to respond on the issues of timeframes raised by the Members; Minister Mkhize would then round up. He said it was important to realise there were issues in the Eastern Cape but some work had been done. 

MEC Gomba indicated that there were 3 536 new beds. In terms of districts, Nelson Mandela Bay Metropolitan had around 350 beds excluding field hospitals; Sarah Baartman District had around 130 beds; Buffalo City had around 220 beds; Joe Gqabi District had around 400 beds; OR Tambo District had around 320 beds; Alfred Nzo District had around 160 beds and Amathole District had around 215 beds. A total of 1 613 of these beds were field hospital beds. The province was continuing to roll out more beds. Areas for beds were also being repurposed – old hospitals had been rebuilt. The beds were waiting to move in once such measures were complete. 

She responded that the Eastern Cape had 447 ambulances. In terms of districts, Amathole District had 15; Alfred Nzo District had 65; Buffalo City Metropolitan had 45; Chris Hani District had 65; Joe Gqabi District had 45; Nelson Mandela Bay Metropolitan had 40 – where ten had also been moved from OR Tambo to take this up to 50; Sarah Baartman District had 50; OR Tambo District had 64. This was what Dr Zungu had been speaking to: the decentralisation of ambulances to be closer to facilities. 

On staffing she indicated that there was an intended number of new staffing to be used for COVID-19 purposes. The usual robust procurement processes could not be followed under these circumstances. She had taken the route of getting contracted workers into the areas they would be necessary in. The projection was 7 438 using databases and short advertisements; 3800 of this 7438 had been found. There remained shortages of doctors but the positions ranged across all essential services at hospitals.

On district managers, four spaces had been concluded. It was not that there were no district managers in the province. New advertisements had been posted as some had moved to chief directors. On chief directors, four positions had been concluded. 

CEOs were a longstanding issue; posts had been advertised. The CEO that had been present during disciplinary processes at a hospital had resigned. This difficult situation had been cleared and opened a space. An acting CEO had been installed while adverts had been run to find a permanent replacement. Names could still be nominated to apply for the position. 

On infrastructure, there was a lengthy report on infrastructure in the province. She suggested that because of directives on the issues of COVID-19, infrastructure was led by the Department of Public Works. It had been decided to renovate existing buildings to have leadership assisting beyond COVID-19. Therefore, they were not building new buildings in the province but adding to and extending existing ones. 

On the issue of healthcare workers, this was not straightforward. She wanted to deal with the issues as soon as possible. The matter had been taken to national level in terms of negotiation. Issues remained around consideration of the fiscal budget.  

Oxygen was currently on supply at 80% of facilities in the province. The whole of South Africa faced consumption issues of oxygen. 

On the issues of OR Tambo and the R4.8 million, she said that this was not a health-related issue; it was a municipality issue. It was unable to be answered. 

The issue of scooters was 90% solved. The mode of the scooter had been agreed. The model could only be changed of the scooter itself. Specific sidecars were required to carry out aspects of primary healthcare. She invited openly that the books be checked to arrest fears of corruption and mismanagement. 

Dr Zungu said, on the timelines dealt with for issues relating to creating labour peace and engagements with unions, that negotiations were taking place with unions to address issues as they arose. In many cases these related to specific hospitals, mostly in the Nelson Mandela Bay metros. The negotiations were ongoing led by the provincial MEC for Health. 

On issues of supply of beds and gaps, many projects were coming into play. The presentation had indicated a baseline and the numbers coming in. The PMU was closely observing the epidemic and its related movements. They undertook daily meetings to understand what happened at facility level to assist the province. There was an electronic dashboard and monitoring of the movement of beds daily. 

On issues of health worker infections, the PMU was focussing on an infection control capacity being developed. This was undertaken by the Professional Health and Safety Committee. Over 2000 healthcare workers had been infected, some had passed away. Some of these were not from the frontline environment. As such, there had been increased focus on infection control regardless of where the health worker would be working. The PMU was closely observing infection control issues. 

On the planning being done and work with other partners, these included the World Health Organisation which was assisting with epidemiology infrastructure in the province. TB HIV Care collaborated with data management and technical assistance. Other partners included the Maternal Adolescent Child Health Organisation and the Clinton Health Access Initiative. 

Co-Chairperson Dhlomo asked the acronyms to be written down and forwarded to the secretary. 

On being requested to provide specific timelines, Dr Zungu explained that some interventions were at facility level, while others were at provincial level – making it difficult to aggregate as there were different timelines. Some had already been completed. The MEC had covered issues of the installation of oxygen and the associated timelines. Dr Zungu requested to provide a report of timelines for different areas of interventions across the province and/or facility level. 

Co-Chairperson Dhlomo said that the provision of this report was critical. 

He handed to Minister Mkhize for closing. 

Minister Mkhize thanked Dr Zungu and the MEC. On health workers figures, he indicated that 1 799 had been affected in the Eastern Cape. These were mostly from the public sector. Four had passed away, while 864 had recovered. The numbers were monitored regularly. Everything was being done to protect workers. A statement would be issued later in the day to provide a comprehensive account.  

He understood the Members’ concerns about so many things still that to be done in the province. He had gone to specific areas in the province to see the renovations being done and the installation of new beds. He could attest to numbers provided by the MEC. He understood the focus was hit or miss, and it had been determined that beds would have to be constantly shifted. This was informed by looking at how the Western Cape, Gauteng and the Eastern Cape had required active management of the numbers. Therefore, it was required to look at how the hospitalisation rate was going and to then respond based on that, irrespective of the original focus of bed placement. 

On the issue of staffing, he said that work was being done nationally to find staff that could be shifted to the province, making use of human resources divisions. People were beginning to move between provinces depending on where they would like to serve. This was a fluctuating number. The Department was looking at using the nursing recruitment agencies. This had been done in Gauteng; it would be done in the Eastern Cape. 

Contract workers issues were not specific to the Eastern Cape; this was a national issue. The unions wanted to make these permanent, with threats of strikes. However, the nature of contract workers had been designed as a community structure; it was not meant to be people on a long-term contract with posts being advertised. It had evolved in various ways, being handled by both NGOs and by government. The issue of minimum wage had been taken into account. 

On oxygen, it had been indicated where oxygen piping needed to be put up in order to ensure there was oxygen at all hospitals. In the past few weeks there had been engagements with manufacturers of oxygen to see where this could be sped up. It was not a new issue. From the beginning of the crisis, it had been known that it would turn into issues of oxygen supply shortages. It had been agreed with oxygen producers that they shift from industrial to healthcare supply. The oxygen producers were in continuous contact. This was a daily management issue until the province was past the surge. There were more areas requiring oxygen. As pressure arose; new tanks would be made available. This was being managed on a continuous basis. An issue was that manufacturing and distribution of oxygen took place in different parts of the province. This meant that there would be stress in moving oxygen to where it was needed. 

Members had asked the question about taking over the Eastern Cape Health Department and the question of why it had not been done. He wished to indicate that Section 100 of the Constitution had two aspects. Section One (a) said that when a province could not or did not fulfil an executive obligation in terms of constitutional or legislative obligations, the national executive may intervene in taking any appropriate steps to ensure fulfilment of that obligation – including issuing a directive to the provincial executive, describing the extent of the failure to fulfil its obligations and stating any steps required to meet its obligations. Section One (b) said that the national executive could also assume responsibility for the relevant obligation in that province to the extent necessary to maintain essential national standards or meet established minimum standards for the rendering of a service, the maintenance of economic unity, the maintenance of national security, or to prevent that province from taking unreasonable action that was prejudicial to the interests of another province or the country as a whole. 

In the preparation for COVID-19; every province had required assistance and support. The Department had gone in to change the programme and strategy of the way work was done. This had been reinforced in the Free State, the Eastern Cape, the Western Cape and Gauteng; all had been sent reinforcements and had required support. These were premature calls to enact Section 100. Therefore, Section 100(a) had not been started. The Eastern Cape was no different to the rest of the country; it had common challenges and weaknesses. Once process in faded; could move in when there was obstruction. Members needed to know the Department was aware of Section 100. It was a possibility but far away. COVID-19 required a united response to effectively manage it. 

Closing Remarks
Co-Chairperson Dhlomo thanked Minister Mkhize for the candid response. 

He said that it would be a comfort to receive such a report containing detailed timelines. He had done oversight in the Eastern Cape and was happy with progress made here and there. Certain issues made him unhappy. He needed to measure progress in the meeting of certain issues. He had spent a whole day in the OR Tambo district. It was the only rural district overwhelmed by infections. It was the district that championed national health insurance (NHI) in the Eastern Cape. There were huge backlogs in terms of infrastructure. This required continuous monitoring. The Committees needed to see progress. He commended Minister Mkhize for the people deployed to support the PMU was a chief director of infrastructure; relying on the Department of Public Works. The Department was not working on its own. He was thankful for the promised provision of timelines. He asked the Department to keep working on the challenges. There was a sense of comfort that it was on the ground in the province. The Committees would continue monitoring and oversight as they had done on all provinces. He said it was reasonable to support Minister Mkhize in the province. The Committees awaited the report. 

There was an additional item that had been supposed to be dealt with in the meeting relating to the plan of action discussion in the impact of alcohol on Health Services. A presentation had been sent. He would request the House Chairperson for another slot to address the matter in another meeting. This was in light of the request from 75 scientists to deal with matters on the impact of alcohol on health. He would request a meeting for the following week. 

He thanked Minister Mkhize, the MEC and the PMU team. 

The meeting was adjourned.