Forms on which clinics report monthly to the central government on the treatment they have given to patients contain, amazingly, no questions about HIV/Aids, the biggest health crisis facing South Africa.
South Africa’s 4 352 clinics, community health centres, mobile facilities and visiting points treat more than 4,2-million people for a variety of ailments. This information is provided through a standard monitoring form of primary health care.
Although the document asks for details of contraceptive protection provided, including the number of condoms dispensed, and provides two- and-a-half pages of definitions, there is no reference to the pandemic that threatens to kill an estimated five million people over the next 10 years.
The definitions include a section on general patients, including mental health cases, psychiatric discharge patients, chronic cases, diabetes, hypertension and epilepsy. In 1999 the monthly average of patients visiting these centres in Gauteng, Eastern Cape and KwaZulu-Natal was 4 239 892, while the monthly average in Mpumalanga, Northern Province and the Western Cape was 1 956 905, and in Northern Cape, North West and the Free State the monthly average was 610 789. These stark details emerged from parliamentary question and answer released in November.
Minister of Health Manto Tshabalala-Msimang spelled out the harsh conditions in some of these health centres: a quarter of the 724 rural clinics in the Eastern Cape are not even accessible by ordinary vehicles. She said 194 of these clinics are not accessible by ordinary vehicles, 167 have no electricity and 197 clinics have no telephones.
The extensive primary health care network in the country is the result of the policies instituted by the government after 1994 whose aims were to de-emphasise the role of large and expensive urban-based hospitals in favour of basic medical needs and to develop a structure of smaller clinics and health centres which are closer to ordinary people. The government emphasised that these clinics and centres should be located where primary health needs should first be treated and that the large hospitals should be used for referrals and more serious cases.
Although there have been criticisms that some of the clinics, particularly in more remote areas, are not adequately staffed and equipped, as well as often being short of basic medical supplies, the latest figures indicate that progress has been made in creating the infrastructure for this primary health care service. Her figures indicate that there were 3 177 clinics on August 10 last year, 98 community health centres, 755 mobile facilities and 322 visiting points.
The Eastern Cape, with 780 of these facilities, had the highest number while there were 664 in the Northern Province, 629 in KwaZulu-Natal, 531 in the Western Cape, 474 in North West, 438 in Gauteng, 386 in Mpumalanga, 298 in the Free State and 152 in the Northern Cape. Tshabalala-Msimang said the Department of Health received information from the provinces monthly in terms of the National Minimum Data Set, which has 20 compulsory “indicators” and 18 optional indicators in a primary health care monitoring form.
These indicators show how many people visited the clinics during the month and the estimated catchment population they were serving as well as giving information about the services they have provided to patients. These include cases of diarrhoea among children under five, severe malnutrition (less than 60% of standard weight), new cases of marasmus or kwashiorkor, tuberculosis, pre-natal visits and deliveries of babies.
Tshabalala-Msimang added provinces are responsible for primary health care programmes and for identifying areas that need additional health care facilities. She also disclosed that there were 5 743 medical officers, 1 962 specialists, 1 207 pharmacists, 45 454 professional nurses, 20 279 staff nurses, 36 986 nursing assistants, 245 medical superintendents, 326 dentists, 1 604 registrars, 402 occupational therapists, 487 physiotherapists, 1 825 radiographers and 142 psychologists in the public health care system, including primary health care facilities. Costs included R55,1-million a month for salaries, R32,6-million for medical supplies and R5,1-million for administration, security and other specified items, Tshabalala-Msimang said.
She said that 106 clinics were being connected to electricity, 50 solar and 56 grid, and the remaining 61 clinics would be electrified as part of the national electrification programme, run by the Department of Minerals and Energy. Tshabalala-Msimang also said two-way radios were provided to clinics without telephones and Telkom was going to start a programme to bring telephones to all clinics.