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National CMAP Health Report Page 1 of 24 National CMAP Primary Health Care Report January 2011 – December 2011 The Black Sash in partnership with the Social Change Assistance Trust or SCAT launched the national Community Monitoring and Advocacy Project or CMAP in 2010 in a bid to help improve government service delivery, with a particular focus on poor and vulnerable communities in South Africa. * “This document has been produced with the financial assistance of the European Union. The contents of this document are the sole responsibility of the Black Sash and can under no circumstances be regarded as reflecting the position of the European Union.”
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National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ......

Apr 27, 2019

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Page 1: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  1  of  24  

       

National  CMAP  Primary  Health  Care  Report    

January  2011  –  December  2011    

               The  Black  Sash  -­‐  in  partnership  with  the  Social  Change  Assistance  Trust  or  SCAT  -­‐  launched  the  national  Community  Monitoring  and  Advocacy  Project  or  CMAP  in  2010  in   a   bid   to   help   improve   government   service   delivery,   with   a   particular   focus   on  poor  and  vulnerable  communities  in  South  Africa.                              *   “This   document   has   been   produced   with   the   financial   assistance   of   the   European   Union.   The   contents   of   this  document  are  the  sole  responsibility  of  the  Black  Sash  and  can  under  no  circumstances  be  regarded  as  reflecting  the  position  of  the  European  Union.”        

Page 2: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  2  of  24  

Acknowledgements      The  Black  Sash  would  hereby  wish  to  thank  the  following  organizations  and  their  community  monitors,  who  volunteered  their  time  to  monitor  health  services  throughout  South  Africa,  including  the  Black  Sash  Regional  Offices  who  coordinated  and  led  the  process.    

 

Adelaide  advice  office   Khari  -­‐  Kude  (Department  of  Education)     Rea-­‐Agana  Support  Group  -­‐Vryburg  

Agang  Aids  Service  Organisation     Khothatsang  VEP   Reach  Bloemfontein    

Age  of  Hope  Centre    and  Economic  Development     Khupukhai  Trading  Enterprise   Reagile  Advice  Office  –  Koster  

Athlone  District  Advice  Office     Khutsong  Youth  Friendly  Service   Reashoma  Community  M.P  Project    Ba   ga   Mothibi   Community   Advice   Centre   –  Losasaneng   Komaggas  Advice  Office     Reatlegile  Community  Centre  –  Mahikeng  

Bantu  -­‐  Bambanani  Aids  Project     Kopano  Women  Venture  –  Morokweng   Rebotile  Creche  and  Pre-­‐School  

Barkly  East  community  Advice  Office   Kopermyn  Advice  Office     REHECAPRO  

Batlhabine  Foundation     Kubonakele  Human  Rights  and  Democracy  Justice  Institution     Relemogile  Advice  Office    

Bavumile  Home  Community  Based  Care     Kutullo  Drop-­‐In  Centre   Richtersveld  Advice  Centre    

Beaufort  West  Advice  and  Development  Office     Kwaguqa  Advice  Office     Riversdale  Advice  and  Development  Centre    

Bedford  Advice  Centre   KwaMakhutha  Community  Resource  Centre     Rouxville  Legal  and  Community  advice  centre  

Berlin  Centre   KwaMashu  Resource  Centre     Rural  Association  Youth  Development    

Bethlehem  Legal  and  community  advice  centre   KwaThintwa  KZN  Deaf  Society     SA  Vroue  Federasie  

Bethulie  Bophelong  Victim  Empowerment  Centre     Kwazulu  Natal  Christelike  Maatskaplike  Dienste   Sandveld  local  Development  

Bloemhof  Advice  Centre  –  Bloemhof   KZN  Deaf  Association     Sasolburg  Advice  Centre  

Bohlabela  Resource  and  Advice  Centre     Land  a  Hand  Home  Based  Care     Sedibeng  Drop-­‐In  Centre    

Bojanala  Advice  Centre  –  Phatsima  (Rustenburg)   Leandra  Community  Advice  Centre     Sekwele  Centre  for  Social  Reflections  

Bomvana  Community  Advice  Centre   Lebaleng  Advice  Centre  –  Makwassie   Senzokuhle  Advice  Centre  

Bonteheuwel  Advice  Office     Lebone  Drop-­‐In  Centre     Senzokuhle  HBC  

Botrivier  Advice  and  Development  Centre     Leewdoringstad  Advice  Centre  –  Leewdoringstad   Sicelukhanya  Home  Based  Care    

Botshelo  Hospice  –  Itsoseng   LEGBO   Sika  Sonke  Drop-­‐in-­‐Centre    Burgersdorp   Community   Resource   and   Legal  Advice  Centre   Lekukela  Old  Age  Home  Centre     Simile  Sonke  Tjakastad  Kwanda  Project    

Cancer  Association   Lesedi  Advice  Centre  –  Vryburg   Sinethemba  CBO    

Carletonville  Street  Children   Lesedi  Home  Based  Care  –  Silverkrans   Siphamandla  Organisation    

Centre  for  Positive  Care   Letsopa  Advice  Office  –  Ottosdal   Siphesihle  HBC  

Centre  for  Research  and  Development     Lotavha  Advice  Organisation     Siyaphambili  N.P  Sites    

Chief  JM  Dlamini  Cheshire  Home     Lovelife  Trust(Hopetown)     Siyavuna  Development  Centre  

Citrusdal  Advice  Office     Lufhano   Siyavuyo  Youth  Centre    

Community  Advice  and  Law  Centre     Lusaka  Khaphunaneni  Shipingwana   Sizanani  Widows  Support  Group    

Community  in  Action     Lusisikiski  Advice  Centre   Sizimisele  HBC  

D'Almeide  Resource  and  Information  Centre     Luvuyo  Drop  In  Centre     South   African   First   Indigenous   and   Human   Rights  Organisation    

Daggakraal  Community  Advice  Centre     Madidimale  Community  Advice  Centre  –  Mabaalstad   South   African   National   Association   fo   the   blind  (SANABP)  

Daliwe  Advice  Centre   Mafefe  Legal  Advice  Office     Spoegrivier  Advice  and  Development  Forum  

Dalmaida  Civic  Association   Mamadi  Advice  Centre     Springs  of  Hope  Support  Group    

Dientjie  Advice  and  Resource  Centre     Mangaung  Advice  Centre     Sun  Rise  Resource  Centre    

Diocese  Aids  Ministry   Mankweng  Community  Law  Advice  Office     Sunshine  Home  based  Care  

Ditenteng  Advice  Office     Manthata  Advice  Centre     Swaranang  Drop-­‐In  Centre      

Dordrecht  Advice  office   Maokeng  Advice  and  Resource  Centre     Swaranang  Home  Based  Care    

Doringbaai  Multi  Purpose  Centre     Maokeng  Association  for  Peopls  living  with  HIV/Aids     Taabosch  Home  Based  Care    

Dryharts  Youth  Connection   Marselle/Bushmans  Advice  Office   Taaibosch  Drop-­‐In  Centre    

DUDEC   Masakhane  Creche  and  Development  Centre     TAC  -­‐  Treatment  Action  Campaign    

Edaneg  Development  and  Advice  centre   Masibonisaneni  Project   Thabang  Home  Base  Care    

El-­‐Shaddai  Drop  in  Centre     Masikhathaklane  Multi  Complex     Thabankulu  Legal  Advice  Centre  

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Elandsbay  community  Development  Org   Masiphakameni  Advice  office   Thabo  Drop-­‐In  Centre    

Elliot  Paralegal  Advice  office   Masmatok  Community  Centre   Thandanani  HBC    

Elsies  River  community  advice  office   Matatiele  Advice  Centre   The  Khuphuka  Project    

Engcobo  comm  legal  advice  centre   Matjabeng  RICC   The  Light  of  Hope    

Ensalabosho  Orphans  and  Disable   Matlala  Advice  Office     Theewaterkloof  Agency  for  Social  Transformation    

Enthembeni  Community  Centre   Mkhuhlu  Community  HBC   Thembelisha  Home  base  care  

Epilepsy  SA  Mpumalanga  -­‐  Limpopo     Mmangwana   Multi   Purpose   Centre   –   Ikopeleng      (Ramatlabama)   Thokozane  CBO    

Fatafata  Thune  Group     Molsvlei  Advies  Kantoor     Tholulwazi  Home  Based  Care    

Flagstaff  Community  Advice  Centre   Montagu  Advice  Office     Thusanang  Advice  Centre    

Fort  Beaufort  Advice  Office   Morojaneng  Advice  Centre   Thusanang  Health  Care  Centre  –  Verdwaal  (Itsoseng)  

Fouriesburg  Advice  Office       Motswedi  wa  Lerato  Development  Centre   Thusanang  Home  Based  Care  –  Delareyville  

Free  State  Network  on  Violence  against  Women     Mpolweni  Child  and  Welfare  Society     Thusanang  Youth  Centre    

Funda  Development  and  Human  Resource  Centre     Mpophomeni  Gender  and  Paralegal     Thusang  Setshaba  Drop  in  centre  

Genadendal  Legal  Info  Desk   Mpumalanga  Council  of  Churches     Thuso  Advice  Centre    

Good  Samaritan  Hospice     Mqandulu  Advice  Office   Tiang  -­‐  Maatla  Pensioner's  Committee    

Grace  and  Mercy  Ministry     Musina  legal  Advice  Office     Tigane  Advice  Centre  –  Hartebeesfontein  

Greater  Harrismith  Paralegal  and  Advocacy  Centre     N2  South  Cape  Rural  Development  Forum     Tirisano  Home  Community  Based  Care    

Greater  Molweni  Community  Resource  Centre     Nababeep  Advice  and  Development  Centre     Tlhabologang  Aids  Forum  –  Coligny  

Gugulethu  Advice  Office     National  Traditional  and  healers  organization   Tlhoafala  Advice  Centre  –  Lehurutshe  

H.M.C.S  Project   Neighbour  helping  Neighbour     Tlhokomelang  Sechaba  HIV/Aids  Project    

Heidelberg  Advice  and  Development  Centre     Nelspoort  Advice  and  Development  Office     Transformed  Individuals  Development  Initiative      (TIDI)  

Heideveld  and  District  Advice  Office     Nelspruit  Community  Forum   Trininity  of  Life  Health  Care  

Hofmeyr  Advice  Centre   Network  Action  Group   Tshedza  Development  Project    

Hope  for  Life  HBC   NICRO  (PMB)     Tshepo  Themba  dev  centre  

Hopetown  Advice  and  Development  Centre     Nkomazi  Advice  Centre     Tshireletsego  Community  Development  &  Care  Centre  –  Ventersdorp  

Human  Rights  Training  and  Development     Nonesi  Advice  Office   Tshirletsho  Against  women  abuse  

i-­‐Themba  Advice  Centre     Nsikazi  Advice  and  Resource  Office     Tshwaraganang  Home  Based  Care  –  Khunwana  

Imithente  Youth  Organisation   Ntataise  Home  and  Education  Centre     Tshwaranang  HIV/Aids  info  care  centre-­‐Jouberton-­‐  

Impumelelo  Project   Ondlunkulu  Working  Committee  of  Unzinyathi  District     Tswelelang  Advice  Centre  –  Wolmaranstad  

Indwe  Legal  Advice  Office   Opret  Advice  Office     Ubuntu  Advice  and  Development  Centre    

Interchurch  Local  Dev  Agency   Paarl  Advice  Office     Ubuntu  Advice  Office  

Itireleng  Home  Based  Care  –  Stella   Patensie  Advice  Office   Umondi  Wesizwe  se  Africaq  

Jeppes  Reef  Home  Based  Care     Peddie  Women  Support  Centre   Umsobombuvo  Women  Development    

Jersey  Farm  Advice  &  Information  Centre   Phedisanang  Home  Based  Care     Umvoti  Aids  Centre    

Jouberton  Legal  and  Human  empowerment  centre     Philani  Support  Group     Umzimkulu  Development  Services  

Juno  Pre-­‐School     Philipstown  Advice  and  Development  Centre     Uncedolwethu  Project    

Justice  and  Peace,Johannesburg   Pholontle  Home  Based  Care  –  Rankelenyane  (Rustenburg)   United  people  against  Crime  (UNPAC)    

Justice  and  Peace,Pretoria   Phunyeletso  Advice  Office     Upington  Advice  and  Development  Centre    

Kabosadi  Disabled  Centre     Pofadder  Advice  Office     West  Rand  Community  

Katolieke  Ontwikkeling  Oranjerivier  (KOOR)     Port  St  Johns   Witzenberg  Advice  Office    

Kempton  -­‐  Tembisa  Advice  Centre     Prince  Albert  Advice  and  Development  Centre     Women  for  Peace  

Kenhard  Drop  in  Centre  and  Advice  office   Protiro     YMCA  

Kgaladi  Creche     Quedusizi  HBC  and  Drop  in  Centre     Zimiseleni  Dots  and  HBC  

Kgatelopele  Advice  Office     Qunu  Community  Advice  Office   Zithuthukise  Womens  Club  

Kgetleng  River  Carers  –  Koster   Quolaqhwe  Advice  Centre      

Kgubetswana  Advice  Centre     Ratanang  Women's  Club    

 The  Black  Sash  wishes  to  thank  the  following  organisations  for  their  financial  commitment  to  CMAP.          

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Contents    Acknowledgements             Page  2  –  4      Background  and  Introduction           Page  5  –  6    

Why  this  project?    The  Project    Methodology    

 Data  Analysis             Page  7  –  10    

Scope,  limits  and  assumptions    Key  Findings  Key  Recommendations  Respondents    

 Findings                 Page  11  –  21    

Findings:  Measurements    Time  Venue  &  Security  Personnel    Language  and  Communication    

 Recommendations             Page  22  –  23      Monitors  Observations             Page  26  –  26                                                      

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Background  and  Introduction      

During  the  period  January  -­‐  December  2011,  the  Black  Sash  and  SCAT  facilitated  the  monitoring  of  health  services  as  part  of  CMAP  in  South  Africa.      The  implementation  came  after  months  of  rigorous  planning  and  consultation  with  local  civil  society  organisations  (CSOs).  These  were  community  based  organizations  throughout  Western  Cape,  Northern  Cape,  Eastern  Cape,  Mpumalanga,  Limpopo,  Gauteng,  and  North  West,  and  Kwazulu-­‐Natal.  Monitoring  in  this  province  focused  on  the  quality  of  services  experienced  by  patients  at  health  clinics.  86  Monitors  selected  from  community  based  organisations,  advice  offices  and  networks,  acknowledged  earlier  in  this  report,  visited  74  clinics  in  the  Central  Karoo,  West  Coast,  Eden  districts  in  Western  Cape,  the  Siyanda,  Namakwa,  and  the  Francis  Baard  district  in  the  Northern  Cape,  Chris  Hani,  Amathole,  Cacadu,  and  Joe  Gqabi  districts  in  the  Eastern  Cape,the  Ehlanzeni,  Gert  Sibande  and  Nkangala  districts  in  Mpumalanga,  the  Vhembe  district  in  Limpopo,  the  Sedibeng,  Ekurhuleni,  West  Rand,  City  of  Tshwane  districts  in  Gauteng,  the  Bojanala,  Dr  Ruth  Segmotsi  Mompati,  Dr  Kenneth  Kauna,  and  the  Ngaka  Modiri  Molema  districts  in  North  West  and  the  Ungungundlovu,  Umzinyathi,  Sisonke,  and  Ugu  districts  in  Kwazulu  Natal.      The  findings  of  this  intervention  are  presented  in  this  report  and  are  accompanied  by  observations  made  by  the  monitors  and  recommendations  made  by  service  beneficiaries  and  the  Black  Sash.      Why  this  project      The  Black  Sash,  a  human  rights  organisation  active  for  the  past  55  years  in  South  Africa,  works  to  alleviate  poverty  and  inequality  and  is  committed  to  building  a  culture  of  rights-­‐with-­‐responsibilities  in  South  Africa.  We  focus  specifically  on  the  socio-­‐economic  rights  guaranteed  by  our  Constitution  to  all  living  in  South  Africa.    Despite  the  principles  of  Batho  Pele  (People  First)  that  has  officially  governed  the  civil  service  for  more  than  ten  years,  we  are  deeply  conscious  that  unaccountable,  corrupt  and  inefficient  service  delivery  ranks  high  amongst  the  many  factors  that  prevent  the  full  realisation  of  these  rights.  We  are  concerned  that  poor  service  delivery  denies  millions  of  people  a  dignified  life,  undermines  the  impact  of  government  spending  on  other  social  protection  programmes,  as  well  as  any  advances  that  have  been  made  to  create  employment  and  currently  leads  to  growing  anger  and  frustration  which  inevitably  results  in  protest  that  often  turns  violent.  These  protests  bring  with  them  the  accompanying  risks  to  the  economy  of  the  destruction  of  infrastructure,  loss  of  work  days  and  human  insecurity.    Similarly,  we  acknowledge  that  the  South  African  Government  is  under  increasing  pressure  to  improve  access  to,  as  well  as  the  quality  and  cost  effectiveness  of,  service  delivery.  Service  delivery  is  a  key  public  determinant  of  the  effectiveness  of  the  state’s  use  of  limited  resources;  a  particularly  important  factor  during  the  

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current  global  financial  crisis.  A  high  standard  of  service  delivery  is  a  fundamental  part  of  the  social  compact  between  the  government  and  the  population  and  in  today’s  more  transparent  world  of  accountability,  the  standard  of  service  delivery  underpins  the  credibility  of  the  government.      It  is  in  this  context,  that  the  Black  Sash’s  CMAP  is  implemented,  in  collaboration  with  other  civil  society  organisations  and  networks.      The  Project      Our  premise  is  that  quality  service  delivery  is  one  factor  that  our  society  should  be  able  to  tackle  even  at  a  time  of  economic  recession  and  that  we,  as  civil  society,  should  hold  our  government  responsible  for  delivering  -­‐  affordably,  appropriately,  effectively  and  with  dignity,  as  promised  in  public  speeches,  ruling  party  manifestos  and  service  delivery  norms  and  standards.      We  argue  that  only  active  community-­‐based  civil  society  will  be  able  to  monitor  service  delivery  as  it  is  experienced  by  beneficiaries  and  constructively  engage  with  government  at  all  levels  to  improve  these  services.  We  believe  that  it  is  only  aware,  informed  and  active  communities  that  will  insist  that  government  deliver  on  the  promises  made  in  national,  provincial  and  local  elections,  and  account  to  their  constituencies  for  policies  and  practices  that  affect  their  quality  of  life.      The  objectives  of  the  project  are  two-­‐fold:  • To  assess  and  report  on  the  quality  of  service  delivery  in  specified  government  departments  and  municipalities  across  South  Africa  as  experienced  by  beneficiaries  

• To  develop  a  system  for  civil  society  organisations  and  community  members  to  hold  government  accountable  for  the  principles  of  Batho  Pele  as  well  as  specific  norms  and  standards  that  govern  service  delivery  and  promise  excellence.    

• Working  closely  with  our  partners,  the  Black  Sash  ensures  widespread,  visible,  standardised  and  regular  monitoring  of  service  delivery  points  by  Community  Monitors  that  are  selected  by  CSO  networks;  

• Co-­‐ordinates  the  development  of  the  monitoring  instruments  and  data  bases;  collates  and  analyses  the  monitoring  information;  produces  and  distributes  regular  reports  to  our  partners  and  the  public;  

• Presents  reports  to  the  appropriate  government  officials  in  order  to  affirm  good  practice  and  to  work  together  to  make  improvements  where  required.    

 CMAP  aims  to  empower  communities  to  access  their  rights  to  social  protection,  basic  and  immigration  services.  It  seeks  to  encourage  service  beneficiaries  to  appraise  the  quality  of  services  they  receive  and,  through  monitors  drawn  from  independent  and  credible  community  organisation  networks,  will  provide  the  opportunity  for  such  beneficiaries  to  express  their  concerns  and  appreciation.      

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This  project  is  built  on  the  tenet  that  citizens  are  not  passive  users  of  public  services  but  active  holders  of  fundamental  rights.  The  Project  will  gather  and  analyse  information  from  the  service  users’  point  of  view  to  provide  a  strong  body  of  evidence  to  take  back  to  government  and,  where  necessary,  into  the  public  domain,  to  better  the  delivery  of  services  where  needed  and  to  acknowledge  good  service  where  it  is  provided.      Methodology    During  the  initial  phase,  the  Project  was  piloted  in  four  provinces.  This  was  to  assess  the  level  of  data  that  will  be  received;  the  relevance  of  the  monitoring  tools  ,monitoring  instruments  and  the  usefulness  of  data  received.  Subsequently  it  was  reviewed  and  amended  where  necessary.      The  methodology  included  a  selection  of  monitors  by  CBOs,  CBO  networks,  civil  society  groups  and  faith  based  organisations  who  are  trained  to  monitor,  orientated  to  the  monitoring  tool  and  committed  by  way  of  a  code  of  conduct.  Each  monitor  identifies  the  day(s),  within  a  specified  timeframe  that  they  will  monitor,  and  the  selected  sites  in  the  communities  where  they  live  or  work.  Once  the  site  has  been  visited  by  the  monitor  and  an  assessment  has  been  done  using  the  monitoring  tool,  the  completed  questionnaires  are  forwarded  to  the  Black  Sash  for  capturing  and  analysis.  The  reports  developed  and  emanating  from  these  analyses  are  forwarded  to  the  relevant  government  department  for  response  within  an  agreed  period,  whereafter  they  will  be  available  to  the  public.      It  is  important  to  note  that  monitors  undertake  the  monitoring  in  the  areas  where  they  live  or  work  and  that  the  selection  of  sites  to  monitor,  depends  solely  on  where  the  monitoring  organisation  is  situated  or  where  the  monitor  resides.  It  is  therefore  clear  that  no  scientific  formulation  is  used  to  select  the  geographic  spread.  However,  we  do  encourage  organisations  with  diverse  geographical  location  to  participate  in  the  project.  This  is  to  ensure  the  data  generated  through  CMAP  does  not  reflect  an  urban  bias.      This  report  reflects  the  findings  and  recommendations  of  monitoring  completed  in  Western  Cape,  Northern  Cape,  Eastern  Cape,  Mpumalanga,  Limpopo,  Gauteng,  and  North  West,  and  Kwazulu-­‐Natal  provinces.                            

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Data  Analysis    This  section  reflects  the  findings  of  the  monitoring  exercise  implemented  in  January  -­‐  December  2011.      Scope,  limits  and  assumptions    Monitoring  was  conducted  by  a  total  of  86  monitors  at  74  different  health  clinics  in  28  districts,  including  Central  Karoo,  West  Coast,  Eden  districts  in  Western  Cape,  the  Siyanda,  Namakwa,  and  the  Francis  Baard  district  in  the  Northern  Cape,  Chris  Hani,  Amathole,  Cacadu,  and  Joe  Gqabi  districts  in  the  Eastern  Cape,the  Ehlanzeni,  Gert  Sibande  and  Nkangala  districts  in  Mpumalanga,  the  Vhembe  district  in  Limpopo,  the  Sedibeng,  Ekurhuleni,  West  Rand,  City  of  Tshwane  districts  in  Gauteng,  the  Bojanala,  Dr  Ruth  Segmotsi  Mompati,  Dr  Kenneth  Kauna,  and  the  Ngaka  Modiri  Molema  districts  in  North  West  and  the  Ungungundlovu,  Umzinyathi,  Sisonke,  and  Ugu  districts  in  Kwazulu  Natal.    There  were  a  total  of  360  respondents  to  the  questionnaires  at  74  different  health  clinics.      In  selecting  a  sample  of  respondents,  monitors  are  advised  during  training  to  interview  at  least  10  beneficiaries  at  a  service  delivery  point.  For  every  10  beneficiaries  interviewed,  one  official  should  be  interviewed.  This  should  be  noted  as  an  encouraged  practice  as  some  monitors  find  it  difficult  to  interview  officials  without  interfering  with  the  service  within  their  2-­‐hour  monitoring  stint.      These  findings  are  the  reflections  of  the  situation  at  the  monitored  sites  on  a  particular  day  and  are  presented  as  a  comparison  across  the  districts  monitored.  The  findings  are  presented  on  the  basis  of  issues  raised  in  the  monitoring  tool  (i.e.  time,  venue,  payment  processing  &  security  personal,  grant  utilisation  and  communication)  most  of  which  are  related  to  the  National  Norms  and  Standards  Policy  for  Social  Assistance  Service  Delivery,  produced  and  published  by  the  Department  Of  Social  Development,  February,  2002.      The  findings  are  compiled  in  individual  site  reports  as  well  as  provincial  reports  such  as  this  one  which  is  fed  back  to  monitoring  organisations  and  their  networks.  These  reports  are  posted  to  the  Black  Sash  website  after  consultation  with  relevant  Government  Departments  and  Agents.      Please  note  the  questions  that  were  not  completed  by  the  monitors  have  not  been  taken  into  account  in  calculating  any  of  the  percentages.      Key  Findings  Key  Recommendations  Respondents  

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Findings    Measurements  The  findings  of  this  intervention  reflects  the  quality  and  efficiency  of  services  provided  by  the  clinics  from  the  view  point  of  beneficiaries’  monitored  on  each  day.  These  are  summarised  below.  The  clinics  were  measured  in  terms  of  the  following:      • Nationality,  Sex  &  Age  Groups  

 • Clinic  Hours  

 • Doctor  and/or  Nurse  Ratings  

 • Travel  Time  and  Costs  

 • Clinic  Efficiency  &  Wait  Time  

 • Privacy  &  Discretion  

 • Patient  Input  

 • Patient’s  Rights  

 • Language  

 • Clinic  Safety  &  Cleanliness  

 • Medicine  

 • Payment  

 • Knowledge  of  Patient’s  Rights                      

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Nationality,  Sex  &  Age  Groups    Of  all  respondents,  the  vast  majority,  at  332,  reported  they  were  South  African,  11  were  Foreign  Nationals,  and  4  were  refugees.    

   The  respondent’s  age  breakdown  mimics  that  of  a  bell  curve,  with  the  majority  (60%)  of  people  between  26-­‐60.  Just  8  people  reported  being  under  18,  52  said  they  were  between  18-­‐25,  74  were  26-­‐35,  79  were  between  36-­‐45,  66  between  46-­‐60,  and  42  people  over  the  age  of  60.      

                 

           

     

South  African,  96%  

Foreign  National,  3%  

Refugee,  1%  

South  African  

Foreign  National  

Refugee  

0,00%  

5,00%  

10,00%  

15,00%  

20,00%  

25,00%  

30,00%  

-­‐18   18  -­‐  25     26  -­‐  35     36  -­‐  45     46  -­‐  60     60  +  

Age Groups

 

Perc

enta

ge

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Females  dominated  the  population,  with  250  females  to  110  males.  

     Clinic  Hours    Participants  were  asked  a  series  of  questions  regarding  clinic  hours  and  days  of  operation    What  time  does  the  clinic  open?  

Earliest  Opening  Time   Latest  Opening  Time   Average  Opening  Time  6:00   10:15   7:38  *21  respondents  from  Limpopo,  North  West,  and  KzN  noted  their  clinic  was  open  24  hours      What  time  does  the  clinic  close?  

Earliest  Closing  Time   Latest  Closing  Time   Average  Closing  Time  15:00   19:30   16:30  *21  respondents  from  Limpopo,  North  West,  and  KzN  noted  their  clinic  was  open  24  hours      How  many  days  per  week  does  the  clinic  operate  from  this  venue?  Most  clinics  are  open  5  days  a  week,  with  over  20%  of  clinics  operating  7  days  a  week.    

Number  of  Days  Open   Percent  of  Clinics  1   .68%  4   8.1%  4.5   1.0%  5   58.8%  6   9.5%  7   21.7%    

31%  

69%   Male  Female  

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Doctor  and/or  Nurse;  Ratings    Nearly  all  participants,  93.3%,  reported  being  seen  by  a  nurse.  A  mere  6.6%  reported  being  seen  by  a  doctor  during  their  clinic  visit.  

   Were  you  seen  by  the  same  nurse/doctor  the  last  time  you  visited  the  clinic?  When  patients  were  asked  the  question  above,  174  said  they  did  see  the  same  nurse  or  doctor,  while  163  said  they  were  seen  by  someone  different.  

   How  did  you  feel  about  the  service  you  received  from  them?  When  patients  were  asked  the  question  above,  53%  rated  their  service  as  FAIR,  32%  reported  it  as  GOOD,  and  13%  reported  it  as  BAD.    

   

0  50  100  150  200  250  300  350  

Doctor   Nurse  

Yes,  52%  No,  48%   Yes  

No  

0  20  40  60  80  100  120  140  160  180  200  

Fair   Good   Bad  

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Travel  Time  and  Costs    Participants  were  asked  a  series  of  questions  regarding  their  travel  time  and  costs  in  traveling  to  the  clinic    How  long  did  it  take  you  to  travel  to  this  clinic?  

Quickest  Travel  Time   Longest  Travel  Time   Average  Travel  Time  0  minutes   300  minutes   38.6  minutes      How  much  did  you  pay  for  traveling  to  this  clinic?  

Smallest  Amount  Spent   Largest  Amount  Spent   Average  Amount  Spent  0  rands   300  rands   11.96  rands      Have  you  come  from  another  district  or  municipality  to  this  clinic?  Only  6%  of  patients  reported  having  come  from  another  district  or  municipality  to  visit  the  clinic.  

                 

0  

50  

100  

150  

200  

250  

300  

350  

Yes   No  

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Clinic  Efficiency  &  Wait  Time    Participants  were  asked  a  few  questions  regarding  how  many  times  they  had  visited  the  clinic,  and  how  long  they  were  made  to  wait.    Is  this  the  first  time  you  visited  the  clinic  for  the  purpose  you  came  today?  237  patients  responded  that  they  had  been  to  the  clinic  previously  for  the  same  health  issue,  while  113  reported  that  this  was  their  first  visit  to  the  clinic  for  their  current  problem.  

                           How  long  did  you  wait  to  be  serviced  after  you  arrived  today?    Shortest  Wait  Time     Longest  Wait  Time     Average  Wait  Time  0  minutes   720  minutes   103  minutes                                

Yes,  32%  

No,  68%   Yes  

No  

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Privacy  &  Discretion    When  you  arrived  at  the  clinic  were  you  given  a  number  or  a  card?  78%  of  patients  reported  receiving  a  card,  while  21%  say  they  were  given  a  number.  

   If  you  received  a  card,  was  the  card  any  different  in  color  from  other  patients?  44%  of  patients  who  reported  receiving  a  card,  say  their  color  was  different  from  other  patients,  while  55%  say  their  card  was  the  same  color  as  other  patients.  

   Do  you  feel  that  you  have  sufficient  privacy  when  seen  by  the  clinic  staff?  Most  patients  reported  they  felt  they  had  ample  privacy,  with  79%  responding  yes.  However,  20%  of  patients  did  not  feel  they  had  adequate  privacy  when  seen  by  staff.    

           

0   50   100   150   200   250  

Card  

Number  

0   50   100   150   200  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

Page 16: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

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Were  you  consulted  in  private?  Nearly  90%  of  patients  reported  being  consulted  in  private,  while  10%  reported  they  were  not.  

   Patient  Input    Have  you  ever  been  asked  your  view  on  how  to  make  health  services  better?  In  a  near  tie,  158  patients  responded  they  had  been  asked  their  view,  while  192  reported  they  had  never  been  asked  their  view  before.  

     Patient’s  Rights    Did  you  know  that  you  may  refuse  treatment  (verbally  or  in  writing)  provided  that  this  does  not  endanger  the  health  of  others?  60%  of  patients  were  aware  they  had  the  right  to  refuse  treatment,  while  40%  did  not  know  their  right  to  refuse.  

   

0   50   100   150   200   250   300   350  

Yes  

No  

Yes,  45%  No,  55%  Yes  

No  

0   50   100   150   200   250  

Yes  

No  

Page 17: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  17  of  24  

Do  you  know  that  you  have  the  right  to  be  given  full  and  accurate  information  about  the  nature  of  your  illness  and  the  proposed  treatment  and  the  costs  involved,  for  you  to  make  a  decision?    Just  over  70%  of  patients  were  aware  of  their  right  to  information,  with  just  under  30%  of  patients  unaware.  

   Do  you  know  that  you  have  the  right  to  be  referred  for  a  second  opinion  to  a  health  provider  of  your  choice?  63%  of  patients  knew  of  their  right  to  a  referral,  and  36%  of  patients  did  not  know.  

   Do  you  know  that  you  have  the  right  to  complain/comment  about  health  care  service  you  receive  and  that  it  should  be  investigated  and  you  should  get  feedback  on  the  investigation  Exactly  70%  of  patients  were  aware  of  their  right  to  complain,  with  30%  of  patients  unaware.  

                       

0   50   100   150   200   250   300  

Yes  

No  

0   50   100   150   200   250  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

Page 18: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  18  of  24  

Where  did  you  get  your  information  about  your  health  care  rights  and  responsibilities?  The  majority  of  patients  learned  their  health  care  rights  from  the  clinic,  with    others  citing  the  media  and  community  as  other  sources.  

   Language    Did  you  receive  information  in  your  spoken  language?  Patients  overwhelmingly  [83%]  reported  having  information  in  their  spoken  language,  though  16%  stated  the  clinic  did  not  have  information  in  their  language.    

               

0   20   40   60   80   100  

Clinic  

Community  

Media  

Unknown  

Monitor  

Friends  

264  

52  

Yes  

No  

Page 19: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  19  of  24  

Clinic  Safety  &  Cleanliness    Is  there  enough  shelter  for  everyone?  The  majority  agreed  that  there  was  indeed  enough  shelter  for  everyone,  with  72%  saying  yes,  and  27%  saying  no.    

     Is  the  service  at  this  clinic  provided  in  a  clean  and  safe  place?  An  even  higher  percentage,  83%  reported  the  clinic  being  located  in  a  clean  and  safe  place,  while  16%  disagreed.    

     

0  

50  

100  

150  

200  

250  

300  

Yes   No  

0  

50  

100  

150  

200  

250  

300  

350  

Yes   No  

Page 20: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  20  of  24  

Medicine    Did  you  receive  medicine  today?  Most  patients,  77%,  at  the  clinic  did  receive  medicine,  while  22%  did  not.    

   If  YES,  how  long  did  you  wait  in  the  queue  to  get  it?    Shortest  Wait  Time     Longest  Wait  Time     Average  Wait  Time  0  minutes   720  minutes   44.9  minutes      Payment    Did  you  have  to  pay  for  service  today?  Nearly  all  patients,  338,  reported  not  paying  for  service,  with  just  12  reporting  they  did  need  to  pay.    

     

0   50   100   150   200   250   300  

Yes  

No  

Yes,  3%  

No,  97%  Yes  

No  

Page 21: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  21  of  24  

Knowledge  of  Patient’s  Rights    As  a  patient  you  have  the   following  responsibilities,  did  you  know?     [To  advise  the  health  care  provider  on  your  wishes  regarding  death]  52%  of  patients  reported  knowing  this  right,  while  47%  did  not  know.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  comply  with  the  prescribed  treatment  or  rehab  procedure  ]  58%  of  patients  reported  knowing  this  right,  while  41%  did  not.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  inquire  about  costs  ]  In  a  similar  split,  57%  of  patients  knew  this  right,  and  42%  did  not.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  take  care  of  health  records  in  his  or  her  possession  ]  Almost  70%  of  patients  reporting  knowing  this  right,  with  30%  not  knowing.  

 

182  

163  

150   155   160   165   170   175   180   185  

Yes  

No  

0   20   40   60   80   100   120   140   160   180  

Yes  

No  

0   50   100   150   200   250  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

Page 22: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  22  of  24  

As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  care  for  and  protect  the  environment  ]  Most  patients,  75%,  were  aware,  while  25%  were  not.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  take  care  of  his/her  health  ]  77%  of  patients  knew  about  their  right;  23%  did  not.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  respect  the  rights  of  other  patients  and  health  providers  ]  Most  patients,  79%,  did  know  their  right,  while  21%  did  not.  

   As  a  patient  you  have   the   following  responsibilities,  did  you  know?     [To  utilize  the  health  care  system  properly  and  not  abuse  it  ]  77%  knew  of  their  right,  while  23%  did  not.  

 

0   50   100   150   200   250   300  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

Page 23: National!CMAP!Primary!Health!Care!Report! · KatoliekeOntwikkelingOranjerivier((KOOR)(( Port(St(Johns( Witzenberg(Advice(Office( ... Ungungundlovu,Umzinyathi,Sisonke,andUgu’districtsinKwazulu’Natal.

National  CMAP  Health  Report     Page  23  of  24  

As  a   patient   you  have   the   following   responsibilities,   did   you   know?     [To   know    his/  her  health  services  and  what  they  offer  ]  72%  of  patients  at  the  clinic  knew  their  right,  while  28%  did  not.  

   As  a  patient  you  have  the  following  responsibilities,  did  you  know?    [To  provide  health  care  practitioners  with  relevant  and  accurate  information.    ]  72%  of  patients  at  the  clinic  knew  their  right,  while  28%  did  not.  

                                                           

0   50   100   150   200   250   300  

Yes  

No  

0   50   100   150   200   250   300  

Yes  

No  

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National  CMAP  Health  Report     Page  24  of  24  

Recommendations              

Monitors  Observations