Tag: GroundUp

Categories : HIV Substance UseTags :

Alarming Rise in HIV among Drug Users as Government Fails to Implement Policy

On By ModernMedia

Needle programs are officially supported, but the state often obstructs them

Photo by Raghavendra V Konkathi on Unsplash

By Jesse Copelyn

Rates of HIV and Hepatitis C are “extremely high” among people who inject illicit drugs, according to new research by TB HIV Care. The organisation tested over 1200 injecting drug users in Tshwane, eThekwini, Mashishing and Mbombela (formerly Nelspruit).

In Tshwane 72% tested positive for HIV and nearly 90% had antibodies for hepatitis C virus (HCV), which could indicate past or present infection.

HCV is a blood-borne virus which damages the liver. When left undiagnosed it can be fatal, though it’s usually curable if treated.

Less than half of those who tested positive for HIV in Tshwane were aware of their HIV status. As such they would not have been on treatment and could have been spreading the virus without knowing.

Survey SiteHIV Prevalence among people who inject drugsAntibodies for Hepatitis C among people who inject drugsShare of HIV positive people who knew their status
eThekwini49%75%76%
Mashishing45%41%77%
Mbombela30%91%64%
Tshwane72%89%48%
Results of the TB HIV Care survey of four cities.

People who inject drugs (such as heroin) are at a higher risk of contracting HIV and HCV when needles are shared – something which happens because drug users don’t have easy access to new ones.

This has long been a problem in South Africa and appears to be getting worse. Research conducted in eThekwini in 2013 found that 17% of injecting drug users were HIV-positive. According to the new research, a decade later the figure has nearly tripled to 49%.

Professor Harry Hausler, CEO of TB HIV Care and a former technical advisor to the National Department of Health on TB/HIV, believes the main reason for this “massive” uptick in blood-borne diseases among drug users is “the limited access to needle and syringe programs” in the country.

Government ignored its own solution

Research shows overwhelmingly that providing clean needles to drug users reduces the spread of HIV, not only by removing the need to share injecting equipment but often because needle programs offer other services such as health education and condoms.

A large review published in 2017 identified 133 academic studies on needle and syringe programs (commonly known as NSP). The results were “supportive of the effectiveness of NSP in reducing HIV transmission among [people who inject drugs], as well as in reducing HCV infection, although the latter to a lesser extent”.

South Africa’s Drug Master Plan, government’s official policy document for managing illicit drug use, explicitly endorses needle and syringe programs, as does the National Strategic Plan on HIV, TB and STIs.

Yet despite these formal policy commitments, there is virtually no public funding for such interventions.

A person discards used needles in a specialised bin provided by TB HIV Care at a mobile clinic in Wynberg, Cape Town.

One exception is the Pretoria-based Community Oriented Substance Use Program, sponsored by the Tshwane Municipality. It has been left to non-profit groups, such as TB HIV Care, to provide these services. According to Hausler, the organisation currently provides clean needles to nearly 10 000 injecting drug users in Cape Town, Nelson Mandela Bay, eThekwini, Tshwane and Mbombela.

Users access needles from drop-in centres as well as mobile clinics – usually vans that get driven on set days to areas where injecting users congregate. Users discard their old needles in specialised bins provided by TB HIV Care. They will then receive a pack, which includes clean needles, alcohol swabs and sterile water.

Nurses are present at the mobile clinics so users can also get tested for HIV and HCV. They also offer ordinary medical services, such as cleaning and bandaging wounds.

Mobile clinics are also manned by psychosocial and human rights workers, and peer educators (people who were beneficiaries but now work for TB HIV Care) from whom users can get counselling or report abuses.

“We’re not just a needle provision organisation”, says Loraine Moses, who oversees quality standards for the program. “We’re a health services organisation”. Users have to register with peers and get health counselling and education before getting their needles, she says.

Beneficiaries have access to various amenities at TB HIV Care’s drop-in centres, including showers, lounging areas and washing machines.

Needle program as a first step to rehab

In many cases, needle and syringe programs also provide a first point of contact for people who want to stop using drugs.

Anthony (surname withheld), previously a heroin user for 15 years, who now volunteers for TB HIV Care, spoke to GroundUp at a drop-in centre in Cape Town.

“In the beginning, I started experimenting with friends in school [but] after my mother passed away, I found that there are those properties in [heroin] that calm you and numb pain, so that’s when I started to delve [into the drug] more.”

After ending up on the street and becoming “a slave to that drug”, he increasingly wanted to get sober. Fetching needles from a TB HIV Care site, he began speaking with one of the peers. The person told him about TB HIV Care’s opioid agonist program, which helps users to quit or reduce their heroin intake.

Opioid agonists are drugs which block heroin withdrawal. Methadone is the most widely known. Numerous clinical trials show that initiatives which offer methadone to heroin users over an extended period are more effective than rehab programs that force users to quit cold turkey.

Hausler says that TB HIV Care currently provides methadone to over 1100 people. Along with the medicine, they receive counselling and are assisted with finding shelter, and in some cases to reintegrate with their families.

Anthony says he’s been taking methadone since June last year. The program also helped him link up with a shelter and get an ID document so that he could find work.

“Being a client at TB HIV Care has helped me a lot to reintegrate back into society,” he says. “Being on the street, you lose a lot of yourself”.

A notice board at the TB HIV Care drop-in centre in central Cape Town.

Law enforcement continues to confiscate needles

Local governments have assisted TB HIV Care with some of its services. The City of Cape Town provides the HIV tests for use at mobile clinics, according to Hausler.

And yet, not only has the government failed to directly fund the sterile needle programs but in some cases it appears to work against them.

Research carried out by TB HIV Care shows that users frequently have their injecting equipment confiscated by law enforcement officers.

In Tshwane and eThekwini more than half of all people surveyed said that the authorities had seized or destroyed their needles at least once in the previous six months.

OutcomeMashishingMbombelaeThekwiniTshwane
No57%76%31%36%
Yes, In the last 6 months18%20%64%54%
Yes, but not in the last 6 months25%4%5%10%

Results of survey question: Have you ever had your needles and syringes confiscated or destroyed by a police officer/law enforcement? Source: TB HIV Care

“What’s very frustrating is that there are two arms of government,” says Hausler. “There’s health and then there’s police. And police are confiscating needles and syringes that we’ve been providing to clients – [even though what we’re doing] is a clearly endorsed health intervention.”

Hausler notes that in some cases the organisation has “really good alliances with local police”, but in other cases it is a constant battle.

“There needs to be better mainstreaming of education of officials across all government departments on the … HIV and TB response [plans],” says Hausler. “If people were really sensitised, we would not run up against as many obstacles.”

Asked for comment, Gauteng SAPS spokesperson Lieutenant Colonel Mavela Masondo told GroundUp that “possession of needles is not a criminal offence. Therefore, we cannot arrest a person [for] possession of needles, and neither can we confiscate needles”.

Note: The full report by TB HIV Care, which received assistance from the United States CDC, is not yet publicly available. A 16 page summary of some of the findings can be found here.

Professor Harry Hausler, CEO of TB HIV Care, at his office in Cape Town.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International Licence.

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Categories : Cancer General InterestTags :

What I Learned on My Journey through Breast Cancer

On By ModernMedia

In Breast Cancer Awareness Month we can all do something to help

Photo by Angiola Harry on Unsplash

By Lee-Anne Bruce

I was diagnosed with breast cancer on an ordinary Thursday afternoon in February 2023. I was 34 years old. The December before, my GP had performed a breast exam as part of a general check-up and was concerned that with my dense breast tissue she might be missing something. She wanted me to have an ultrasound, but there was no rush. Her exact words to me were something like: “Don’t worry, it can wait until you have medical aid savings again in January.”

The ultrasound turned up a small shadow, just a centimetre in diameter – something that could be a cyst, but the radiologist thought we should do a mammogram “just in case”. Would I mind waiting? No, I wouldn’t mind. The mammogram was worrying enough that she got approval to do a biopsy the next day. “Just in case”. The results came in the following week.

I had none of the risk factors for breast cancer. I didn’t drink, didn’t smoke, didn’t have any family members with a history of breast cancer, was nowhere near the age of 50. A few months later, I would find out I had none of the genetic markers which can predict risk either – not only did I test negative for the genes associated with breast cancer called BRCA 1 and 2, I didn’t have any of the genes connected with any kind of cancer at all.

As I say, I was diagnosed on a Thursday afternoon. I had my first appointment with an oncologist that Friday morning. I had my first set of scans two days later on Monday and my initial surgery the following Friday. I started chemotherapy treatment within three weeks of first having the word “cancer” used in relation to my body. My doctors moved quickly because they had to. On a scale of 1 to 9 on something called the Bloom and Richardson classification, my cancer was a 9. So, even though I was only stage 1, I was also a grade 3. “Aggressive” doesn’t begin to cover it.

During this time, I held onto five facts. First, we had caught the tumour at exactly the right time. Had I gone in for screening any earlier, we might not have found the cancer yet. Had I gone any later, it likely would have grown and spread to my lymph nodes and other parts of my body and I might have needed more radical treatment and surgeries. Second, it was treatable. My particular kind of cancer ought to respond well to a combination of chemotherapy and radiation. Third, I was otherwise very healthy, aside from the cancer. Fourth, I had a medical aid which was covering almost everything I needed. And, most importantly, fifth, I had a wonderful support system of my partner and his family and our close friends to rely on.

From the beginning, I had an incredible standard of care. To the point where the doctors I saw had heated examination beds – they didn’t want their patients to experience any additional discomfort and distress during such a difficult time. And it was difficult. Chemotherapy and immunotherapy left me feeling battered and broken. Nausea, intense muscular pain, fatigue, vomiting, diarrhoea, constipation, weight gain, hair loss, brain fog, depression – some of the awful side effects it’s impossible to really prepare for. In fact, I had such a hard time mentally during treatment that at one point I had to be hospitalised.

The same day I received my diagnosis, I overheard a woman in my doctor’s office asking if it was possible to make a payment plan for her treatment. The administrators replied that treatment was likely to cost in excess of R300 000 at a minimum. I cannot even begin to imagine having to go into debt to fight off cancer. For treatment that makes you feel more than just sick, more like you’re dying. For treatment that may not necessarily work.

But this is the choice that faces most people with cancer in our country. With a relatively small number of people on comprehensive medical aids with screening benefits and prescribed minimum benefits, many face waiting for treatment in government facilities or running up huge bills at private clinics.

According to the most recent report by Statistics SA, breast cancer is the most commonly diagnosed cancer in women in South Africa, accounting for 23% of all cancers. It is also one of the most deadly, representing 17% of cancer deaths in women, just behind cervical cancer.

The Stats SA report lists “awareness of the symptoms and need for screening” as the main intervention to reduce the risk of death by breast cancer. The report also draws attention to the discrepancy in mortality rates in different population groups. For example, Coloured women have a relatively low incidence of breast cancer, but a high mortality rate – meaning that they are dying of breast cancer after being diagnosed too late. Stats SA points out that this is likely due to “poor access to cancer treatment facilities” as well as a lack of medical aid coverage. It is perhaps unsurprising that Black and Coloured women are the groups least likely to have medical aid in South Africa.

There are also some NGOs trying to step in to fill the gaps, like the aptly named I Love Boobies or the PinkDrive. These organisations make it their mission to give women a fighting chance to beat breast cancer. They provide free screenings to women around the country who would otherwise not be able to afford this necessary medical care.

I am one of the lucky ones. I officially went into remission on 30 August 2023 when I had a lumpectomy to remove the tumour in my right breast. Remission means that the cancer can no longer be detected in your body through scans and blood tests. It doesn’t mean you’re “cured”. There could still be cancerous cells in the body, which is why cancer is also often treated with radiation like mine was. Some people prefer not to use the term “survivor” until they have been in remission for over five years.

Five years is an important milestone for many people diagnosed with cancer. It’s often the period in which someone is most likely to suffer a relapse. I live with the possibility that my cancer will come back every day; I am reminded by my scars and by the fact that I am still recovering physically and mentally from a traumatic year. I still battle with periods of fatigue and depression and I will never be the same person I was before falling ill.

Still, remission is better than relapse. So far, so good. I continue to see my myriad of doctors every few months for scans and tests and examinations to check that nothing has come back yet and I feel like I’m getting stronger.

Almost a year to the day after I went into remission, my fiancé and I ran the Johannesburg Women’s Race in support of the PinkDrive. A mobile health unit was parked on the field in Mark’s Park offering free screenings all morning, which women were queuing up to access after the run. The festive atmosphere was bittersweet to me. Certainly, some of the women in that line would not know that they were starting on a long and painful journey, a journey which sometimes feels like it has no end. Hopefully, they would be starting early enough to be given a chance to become a survivor.

There’s another meaning of “remission” I wasn’t aware of until I looked it up. It can also be defined as “a cancellation of debt”. No-one with cancer should have to crowdfund in order to get treatment, but that is the reality we are faced with in our country. This October, I encourage everyone to contribute in whatever way they can to a cancer survivor’s remission. Join the Imagine Challenge, try a secret swim, pick up a pink bottle of milk or a scrunchie, support someone raising funds on GivenGain, get yourself examined. Every one of us can join the fight against breast cancer.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International Licence.

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Categories : Ethics and LawTags :

SIU Takes Aim at Ballooning Dodgy Medical Litigation that is Costing the Government Billions

On By ModernMedia
Photo by Scott Graham on Unsplash

By Sandiso Phaliso for GroundUp

Payments of medical related legal claims (medico-legal) against the Department of Health ballooned to R2.7-billion in 2023. In 2013, it was R265-million. This is according to the Special Investigating Unit (SIU) when it briefed the Standing Committee on Public Accounts (SCOPA) last week.

SIU head advocate Andy Mothibi told SCOPA it found evidence of collusion between attorneys, touts, nurses and doctors, in both public and private healthcare. Some law firms also withdrew claims when the SIU started investigating them. This had stopped about R3-billion in fraudulent claims, he said.

Claims under investigation included those targeting families with children born with cerebral palsy, false claims of medical malpractice in state hospitals, and collusion between state healthcare workers and rogue lawyers to unlawfully secure private medical records to initiate claims against the government.

They uncovered cases of agents of rogue law firms impersonating officials of the South African Social Security Agency to secure powers of attorney on behalf of victims by claiming to be securing them social grants. He said they found two attorneys pursuing identical claims for the same individual in two different courts, and for vastly different amounts, in one case for R7.5-million and R25-million for the same patient and same condition

Mothibi said the health sector experienced an explosion of medical practice litigation cases in 2015, directed against health institutions and individual medical practitioners in both public and private practice.

Mothibi said in one case a claimant demanded R70-million for a supposedly botched circumcision at a Limpopo hospital when no circumcision had been performed.

Read the SIU presentation to Parliament

In 2017, the SIU started targeting provinces with the highest share of claims. At that stage, the Eastern Cape’s contingent liability for medico-legal claims was R15.9-billion; in Gauteng, it was R21.2-billion.

In the Eastern Cape, most medico-legal claims emanated from one Johannesburg-based law firm, Nonxuba Attorneys Incorporated. In five years, from 2012 to 2017, the firm submitted 44 claims totaling R497-million against the provincial health department. Nine claims for children born with cerebral palsy were identical each demanding R15-million.

“This was suspicious and indicated a lot of cut-and-paste on the part of this legal firm,” said Mothibi.

The company has, according to Mothibi’s presentation, been charged.

We have been unable to get hold of Nonxuba Attorneys and Business Day has previously reported that the company’s owner, Zuko Nonxuba, has been suspended from legal practice.

Also, in the Mthatha High Court claims increased from 46 to 529 between 2010 and 2016. There was collusion, said Mothibi, between some officials in the Office of the State Attorney, whereby out-of-court settlements for hefty sums were entered into without the mandate or even the knowledge of the department.

MP Veronica Mente-Nkuna (EFF) wanted to know the names of the legal firms implicated besides Nonxuba Attorneys and what the legal bodies have done about their operating licences.

She asked why the Department of Health had not conducted its investigations before the claims were paid. Who was responsible for the loss of money through these fraudulent claims, she asked.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : UncategorizedTags :

Angry Doctors Write to Minister About Unpaid Road Accident Fund Bills

On By ModernMedia

“We implore you to intervene,” medical experts say to Barbara Creecy

By Tania Broughton

A group of more than 70 experts from all branches of medicine say they are all owed money for professional services from the Road Accident Fund – some for as long as seven years.

They have now written to Minister of Transport Barbara Creecy asking for her urgent intervention in what they say is a “disastrous situation”.

“We implore you to intervene and install a leadership in the RAF which is able to carry out its proper functioning with integrity and honesty … we are hopeless and tired,” they said in a letter to the minister.

The letter to Minister Creecy, dated 12 July, was a follow-up to one written in early June to the previous minister Sindisiwe Chikunga. There was no response to that.

Since then, dozens more specialists, including surgeons, psychologists and occupational therapists – who are collectively owed more than R150-million – have added their signatures to the document.

But the fund says it owes them nothing.

“The same people rehash this topic every time there’s a new Minister of Transport,” RAF head of corporate communications, McIntosh Polela said.

He said the experts had not been appointed by the fund but “allegedly by its former panel of attorneys”. The Service Level Agreement with the attorneys specifically stated that medical experts could only be engaged upon written authorisation of the fund. And the fund would not be liable for any fees charged without this authorisation.

He said the vast majority of the experts’ unpaid claims had not been authorised by the fund. This was due to the negligence of former panel attorneys.

In the letter to Creecy, clinical psychologist Monique Kok said the expert appointments were legal.

And, she said, their reports were being used in courts to assist in settling matters.

The fund, she said, was “finding new and cunning ways of explaining and nullifying the expert’s authority to have performed such assessment”.

She said each assessment had been done after some form of written instruction, either from the RAF directly or their panel of attorneys.

“The experts have never acted on their own accord and gone out and somehow magically found the current claimants and performed assessments that cost time and resources without instruction from the RAF or their attorneys.”

Kok said the fund’s refusal to pay their invoices had had a dire impact with some going out of business and losing their homes.

In the follow-up letter to Creecy, psychologist Chris Sampson said the experts wanted a meeting with the minister.

“We have diligently serviced the public for many years by assisting the RAF and the courts in determining appropriate compensation for claimants who were injured in serious motor vehicle accidents.

“It would appear that the organisation (and its leader’s) treatment of its own appointed experts gives us the impression that it has been allowed to become a law unto itself and from court cases it further appears that it refuses to pay claimants, experts or abide by court orders.”

Sampson said the experts conducted “painstaking investigations” and did extensive reports which were being used by the fund and yet were waiting seven years later to be paid.

They had paid out of their own pockets the significant costs of translators, transcribers, equipment and testing material.

“We believe that the state and specifically, your ministry, has a duty to intervene in what has become a well-documented failure, where this statutory body has not carried out its stipulated functions due to either, incompetence, poor leadership, arrogance and/or a fundamental evasion of responsibility and fiduciary duties,” he said.

Speaking to GroundUp, Sampson said he personally was owed about R3-million. Payments had become sporadic since about 2017, and after the Covid pandemic, had completely dried up.

“They come up with a multitude of excuses. They claim we didn’t deliver the reports on time. They repeatedly lose invoices. They say the payments are not loaded on their system , and so there must be something wrong but they don’t tell us what’s wrong. They also accuse us of charging above the tariff when they set the tariff.”

Sampson said litigation, for most, was not an option. “We don’t have deep pockets. And because we have not been paid there is nothing rattling in them.

“But we cannot throw away seven years of hard slog. We have nothing left to lose and we just hope the new minister has the zeal and energy to finally deal with the problems at the fund.”

Creecy’s office has acknowledged receipt of the two letters but attempts by GroundUp to get comment from were unsuccessful.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Ethics and Law HospitalsTags :

Court Finds Netcare Failed to Protect Employee Against an Abusive Surgeon

On By ModernMedia

Operating theatre manager wins her case

Photo by Bill Oxford on Unsplash

By Tania Broughton

The former manager of an operating theatre at Universitas Hospital has successfully sued Netcare for failing to protect her and take action against an abusive surgeon because, she claimed, it was well known that he was a “money spinner” for the company.

Tilana Alida Louw also sued Dr Stephen Paul Grobler but, following his sudden death in June 2022, entered into a confidential settlement agreement with the executor of his estate.

She then pursued her case against Netcare Universitas Hospital.

In a ruling this month, Bloemfontein High Court Judge Ilsa van Rhyn directed Netcare to pay her R300 000 for damages, past and future medical expenses, and to pay part of her costs on a punitive scale.

Louw was appointed as surgical theatre manager at the hospital in 2005. Her role was to oversee and manage operating theatres and theatre staff and monitor patient care.

At that time, she was warned by the then hospital manager, and others, that Grobler had an “aggressive type personality”.

She said she soon experienced first hand his temper tantrums.

In her claim, she said he had verbally abused her continually, hurling profanities, insults, using blasphemous language and obscenities at her in the presence of other operating theatre staff and even members of the public.

She said Netcare had failed to come to her assistance, in spite of her numerous requests and complaints.

Netcare had also failed to act against Grobler, even though it was common knowledge that he behaved this way.

Louw alleged that Netcare had failed in its legal duty to create a work environment free from verbal abuse and intimidation and to take reasonable care of her safety and protect her from psychological harm.

As a result she was humiliated, degraded and suffered shock, anguish, fear and anxiety. She experienced post-traumatic stress syndrome.

She wanted to be compensated for this. And she wanted Netcare to publish a written apology in a local newspaper.

Netcare defended the action. It denied that it had breached its duty to Louw and said it had taken action against Grobler.

After Louw and her witness, labour law expert Professor Halton Cheadle, testified, Netcare offered to pay her for damages and to apologise.

Louw accepted the financial offer, but she was not happy with the wording of the apology and the scale of costs tendered.

And so the trial continued.

Read the judgment

Judge van Rhyn said Louw had testified that her complaints and those of others had been largely ignored by management.

“She explained that several of the scrub nurses refused to work with Dr Grobler and she would step in and assist him during surgeries. Her sense of duty and pity for the patients, many of them being cancer patients who were in dire need of urgent and timeous surgeries, caused her to bear the brunt and endure the constant abuse.”

Louw had said she and other personnel were “not allowed” to lay complaints against Grobler because he was a “so-called money-spinner for Netcare”.

Cheadle, in his evidence, said given the number of grievances lodged against Grobler and given Netcare’s professed zero-tolerance approach to harassment, a reasonable employer would have warned Grobler about his behaviour after the first complaint and would have terminated his contract at the very least, after the third complaint.

Judge van Rhyn said Netcare’s offer of damages during the trial had been made after Louw had endured years of abuse at the hands of Grobler and eight years of litigation.

“I also agree with argument on behalf of the Plaintiff (Louw) that Netcare evidently allowed its employees to be abused by Dr Grobler for its own financial interests. Netcare was acquainted with Dr Grobler’s disgusting behaviour even prior to her (Louw’s) appointment as the unit manager,” she said.

This conduct was deserving of a punitive costs order, the judge said.

Louw had rejected the proposed apology because it contained the words “we apologise sincerely that you felt that Netcare did not sufficiently support you”.

The judge said she agreed with Louw’s perception that this did not, in its plain and ordinary meaning, convey a sincere regret and remorseful apology.

She said she had been informed during argument that Netcare had published the apology in the local newspaper.

However, she said, she would not make any order regarding the apology, because it would not be lawful in a case which was not based on defamation.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Healthcare Politics and RegulationsTags :

Gauteng Non-profit Organisations Reject Findings of Province’s Forensic Probe

On By ModernMedia

Six out of 13 drug rehabs previously funded by the Gauteng Social Development Department are now “under investigation”

Photo by Scott Graham on Unsplash

By Daniel Steyn and Masego Mafata

Non-profit organisations whose funding by the Gauteng Department of Social Development has been withdrawn say they are being unfairly punished for “frivolous” and “flimsy” findings made by forensic auditors.

Among the organisations concerned are women’s shelters, drug rehabilitation centres and organisations that provide meals and social work services to homeless people. Many say they have no choice but to scale down their services and even close their doors.

Only seven in-patient drug rehabilitation centres, out of 13 that received funding last year, will be receiving funds for the first two quarters of this financial year, the department confirmed to GroundUp on Wednesday. Six rehabs are under investigation, the department said. 

A manager at a children’s home told GroundUp earlier this week that they had to send a teenager struggling with substance use disorder back to their family because there were no state-funded in-patient drug rehabilitation centres available in the West Rand.

Forensic auditors were appointed by the department in 2023 to probe allegations of maladministration and fraud in the non-profit sector. The department’s budget for non-profit organisations is R1.9-billion for 2024/25, but Gauteng premier Panyaza Lesufi has promised it will be increased to R2.4-billion. Fourteen department officials have been suspended based on findings of forensic audits, the department has said.

The forensic audits were supported by outgoing MEC Mbali Hlophe. Hlophe has claimed several times that non-profit organisations in the province were “stealing from the poor” and that there has been extensive corruption in the sector.

A report provided by the department to the Gauteng Care Crisis Committee last week, on the orders of the Gauteng High Court, contains a list of 53 organisations that are under investigation, out of several hundred funded by the department.

Among the organisations on the list are Daracorp and Beauty Hub which received millions of rands in subsidies for training, while others have had their budgets cut.

But while organisations such as these have received large amounts of funding under questionable circumstances, the department has not provided evidence that this applies to all organisations on the list.

In May, almost two months into the new financial year, organisations flagged in the investigations started receiving letters informing them that they would not receive funding due to the findings made by the auditors. Some only received the letters in June.

When they requested clarity from the department, some received details in writing. But others were only given reasons for the suspension of their funding during a meeting with the department’s lawyers on Wednesday.

GroundUp spoke to representatives of five organisations who attended Wednesday’s meeting. They said the findings they were presented with on Wednesday were minor issues that should have been picked up by the department’s own monitoring and evaluation teams and would have been quickly resolved. They said they did not understand why a forensic audit was necessary.

The organisations have not received any funding from the department since the end of the financial year in March, and are battling to keep going.

“Flimsy and frivolous”

Derick Matthews, CEO of the Freedom Recovery Centre, which until March was funded for 52 beds for in-patient drug rehabilitation, told GroundUp that the allegations against the centre are “flimsy” and “frivolous”.

Matthews was told at Wednesday’s meeting that Freedom Recovery Centre had not submitted audited financial statements for 2022. GroundUp has seen evidence that he submitted the audited financial statements.

Matthews said the department had never before raised concerns about the organisation’s compliance with legislation. He said every quarter the department’s monitoring and evaluation officials would check the centre’s financial statements and that no concerns had ever been raised.

The auditors also found a “high turnover of security personnel” at Freedom Recovery Centre which was causing “instability in the organisation”. Matthews explained that this was because the security staff are employed from the centre’s skills development programme, through which a person who has been sober for a year works for three to six months at the centre.

“They are paid salaries from DSD funding. Our security is not working directly with the residents so they cannot impact the stability of the centre,” Matthews said.

The third finding against Freedom Recovery Centre was that staff members were being given “loans”. Matthews explained that sometimes when the department paid subsidies late, the centre would pay part of staff salaries from the tuck shop’s funds, which would later be deducted from their salaries.

Matthews says that they are in the process of discharging their last state-funded patients. “Both government-funded centres that we have been told to send people to during this crisis are full, they can’t help us. In the last week, I’ve received about 12 phone calls of people that needed urgent help and we can’t even help or intervene,” he said.

Representatives of other organisations GroundUp spoke to had similar concerns about the findings against them but did not want to be named for fear of victimisation.

They also raised concerns that their meeting on Wednesday was with only one department official and the department’s lawyers, while the organisations themselves did not have lawyers present.

They were told they have until Monday to provide evidence to dispute the allegations against them.

At the meeting on Saturday convened by Gauteng Premier Panyaza Lesufi, it was agreed that the organisations would receive an interim service-level agreement from the department by Monday, which would be finalised once the organisations were cleared. But not one organisation GroundUp spoke to has received an interim service-level agreement. Then on Wednesday they were told they will receive the agreements next week.

One organisation under investigation, Child Welfare Tshwane, was finally paid by the department last week after Gauteng High Court Judge Ingrid Opperman issued a directive that the organisation be paid to prevent harm to the beneficiaries.

GroundUp sent detailed questions to the Gauteng Department of Social Development, but we were told that the department will not be responding to media queries relating to the non-profit sector until further notice.

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Categories : Healthcare Politics and Regulations Substance UseTags :

Almost Half of State-funded Drug Rehab Beds in Gauteng Under Threat

On By ModernMedia

Organisations are “under investigation” but have not been told why

Photo by Colin Davis on Unsplash

By Daniel Steyn, Masego Mafata and Raymond Joseph

The Gauteng Department of Social Development has decided to defund more than half of its existing capacity for inpatient drug rehabilitation in the province.

The department funded 571 beds in 13 non-profit organisations in the 2023/24 financial year, but at least five organisations, with 246 of these beds, will not be funded in the 2024/25 financial year.

The five organisations to be defunded – Westview Clinic Empilweni Treatment Centre, Golden Harvest Treatment Centre, Freedom Recovery Centre and Jamela Rehabilitation Centre – have been providing inpatient treatment for several years, but they have not received subsidies since the end of the last financial year.

Organisations GroundUp spoke to said they received letters from the department in the past few weeks informing them that they would not receive funding due to ongoing investigations. But they had not been told why they are under investigation, they said.

Representatives of FSG Africa, a forensic auditing firm appointed by the department, briefly visited some of the centres earlier this year, but the centres received no feedback on the progress or outcome of these investigations.

The auditors spent less than two hours at most of the facilities, asking only a few questions before leaving, the organisations said.

The organisations said they are yet to receive a report on the findings of the investigations. Queries they sent to the department have gone unanswered.

In previous years, the funding process was managed at a regional level, but this financial year it was centralised, cutting out the regional officials who would usually be in direct contact with the organisations. This has caused catastrophic delays.

Several of the organisations have been operating without departmental funding since March, depleting their savings and taking on debt, and having to short-pay staff salaries.

The department’s spokesperson Themba Gadebe confirmed to GroundUp that the organisations are under investigation, but did not provide details on the allegations.

In October 2022, Premier Panyaza Lesufi said treatment for substance abuse disorder was a priority. Yet the department has decided to defund beds in treatment centres without a clear plan to replace the lost capacity.

Gadebe said the department’s state-owned facility in Cullinan, near Pretoria, which has 288 beds, is undergoing renovation to increase its capacity. But he did not provide further details or timelines for completion.

Sedibeng’s only inpatient centres face closure

The only two drug rehabilitation centres with an inpatient programme in the Sedibeng region of Gauteng, with 116 funded beds between them, will be defunded this financial year.

One of these, Freedom Recovery Centre, was funded last year for 52 of its 94 beds (the remainder are for private patients). CEO Derick Matthews says when they received the department’s letter on 23 May “our world came crashing down”. What shocked him most was that there had been no warning that funding would stop.

Freedom Recovery Centre received a visit from the forensic auditors in March, who spent just two hours at the centre. They asked to see vehicles that the centre had supposedly received from the department.

“I was shocked by this request because we have never received vehicles from the department. But the auditor said that, according to their list, we had received vehicles from the department,” said Matthews.

“We are being punished for something. But we don’t even know what our transgression is,” he said.

On Monday, Freedom Recovery Centre began the process of discharging patients who were nearing the end of their treatment plans, as they can no longer afford to care for or feed them.

“We’ve had to take out loans for the past few months because of the delays in finalising service-level agreements and paying subsidies,” said Matthews. The centre has racked up more than R2-million in debt.

“Our staff are entering the third month of working without pay. Eskom is going to cut our electricity some time this week, because we are in arrears, and then we won’t even have water, because we rely on electricity to pump our boreholes. There are no funds left to keep the centre going,” said Matthews.

He said the centre will have no choice but to close completely in the coming weeks.

The other inpatient programme in the Sedibeng region, Jamela Recovery Centre, funded for 64 beds in 2023/24, faces a similar fate. CEO George Sibanda said they were relying on food donations from community members to feed their patients.

“We have been fully funded by the department since 2018 and our services are offered at no cost,” Sibanda said.

“We always had a backlog of patients. Our waiting list is sitting at 60 people so we were relieved when the department informed us that we would be getting additional beds in March this year. But what we don’t understand is how we must now provide a service to those patients if the department is not funding us this year?” said Sibanda.

Jamela also received a visit from the forensic auditors in March.

Despite not receiving any subsidies this financial year, Sibanda said the centre has been operating at full capacity.

“The department continued to refer people to us and we couldn’t turn them away,” he said.

Social workers at the centre have had to use their own money to pay for petrol for the centre’s car, which they use for outreach programmes.

Department spokesperson Themba Gadebe said that the closure of both centres in Sedibeng was not a concern as “the department prefers the placement of individuals within inpatient facilities far from where they reside, to limit the risk of them checking out or being contacted by those within their substance use networks.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : Diseases, Syndromes and ConditionsTags :

“Silent Disease” Outed at African Hepatitis Convention

On By ModernMedia

Many South Africans with hepatitis go undiagnosed

By Liezl Human for GroundUp

The African Viral Hepatitis Convention, held in Cape Town, has put a spotlight on the need to eliminate from the African continent hepatitis B and C, the “silent disease”.

The World Health Organisation(WHO) says Africa “accounts for 63% of new hepatitis B infections, and yet only 18% of newborns in the region receive the hepatitis B birth-dose vaccination”.

In South Africa, 2.8-million people are infected with hepatitis B and 240 000 have chronic hepatitis C. Of those with hepatitis B, only about 23% have been diagnosed.

The convention, hosted by The Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) in conjunction with the International Hepato-Pancreato Biliary Association (IHPBA), took place over several days.

On the last day, a declaration was adopted, demanding the “immediate prioritisation of national elimination plans”, allocation of resources domestically, and the political commitment to eliminate hepatitis.

“As a community of people living with viral hepatitis, advocates for those living with viral hepatitis, healthcare workers, academics and those who simply care, we say no more … All the tools to eliminate viral hepatitis are available and are uncomplicated interventions,” the declaration read.

Hepatitis B

– Liver infection caused by the Hepatitis B virus

– Usually transmitted from mother to child, as well as between children under the age of five, and via injection drug use and sex in adults

Source: Wikipedia

Hepatitis C

– Liver infection caused by the Hepatitis C virus

– Usually transmitted by injection drug use, poorly sterilised medical equipment, needlestick injuries, and transfusions

Source: Wikipedia

The convention follows a WHO 2024 global hepatitis report that says globally deaths are on the rise and that 1.3 million people died of viral hepatitis in 2022, with hepatitis B causing 83% and hepatitis C causing 17% of deaths.

In Africa, 300,000 people died from hepatitis B and C. This is despite having the “knowledge and tools to prevent, diagnose and treat viral hepatitis”.

There are vaccines available for hepatitis B, and hepatitis C can be cured with medication. Hepatitis B is spread through blood and bodily fluids.

Hepatitis-related liver cancer rates and deaths are also on the rise, according to the WHO report.

At the convention Mark Sonderup, a hepatologist at Groote Schuur Hospital, said, “Inaction now results in a bigger problem later.”

Danjuma Adda, former president of the World Hepatitis Alliance, spoke about stigma as barriers to receiving care.

“Because of high stigma we have low testing because people are not motivated to be tested … We need to change the narrative,” he said.

Anban Pillay, the deputy director-general of the National Department of Health, said that at a national level, guidelines around hepatitis education and treatment can be created, but there “has to be advocacy at a local level” too. He also stressed the importance that voices of patients on the challenges they face be heard at a national and provincial level.

Pillay said that the conference had highlighted “gaps in our programme” and that it will identify and implement interventions that have worked in other countries.

At the end of the last session of the hepatitis convention, the declaration was read and signed by those in attendance.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : CancerTags :

Activists and Patients March on Gauteng Health Department Demanding Radiation Treatment

On By ModernMedia

Nearly R800-million set aside for radiation treatment outsourcing has not been spent

Activists and patients marched on Tuesday in Johannesburg demanding radiation treatment for cancer. Photo: Silver Sibiya

By Silver Sibiya for GroundUp

Activists and cancer patients marched to the offices of the Gauteng department of health on Tuesday demanding that millions of rands allocated for radiation treatment for cancer patients be used.

SECTION27, Cancer Alliance and Treatment Action Campaign (TAC) called for the department to use R784-million set aside by the provincial treasury in March 2023 to outsource radiation treatment. They say not a single patient has received treatment through this intervention a year later.

In an open letter to health MEC Nomantu Nkomo-Ralehoko last week, Khanyisa Mapipa from SECTION27, Salomé Meyer from the Cancer Alliance and Ngqabutho Mpofu from TAC said that in March 2022, Cancer Alliance had compiled a detailed list of approximately 3000 patients who were awaiting radiation oncology treatment.

They said there were shortages of staff in the two radiation oncology centres in Gauteng, Steve Biko Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital. Charlotte Maxeke Hospital had only two operational machines compared to seven in 2020. Tenders for new equipment had been delayed and the backlog of patients was increasing, they said.

As a result, SECTION27 and Cancer Alliance had asked the provincial treasury to set aside R784-million to outsource radiation treatment. The money had been allocated in March 2023, but a year later, no service provider had been appointed.

“It has actually been four years since the matter was brought to the Department of Health,” said Mapipa on Tuesday. She said cancer patients were not getting the treatment they needed.

“We as Cancer Alliance and SECTION27 ran to Gauteng Treasury to ask them to allocate these funds. Gauteng Treasury responded and they gave this money, but this money is still sitting.”

Thato Moncho, who was diagnosed with breast cancer in September 2020, is one of the patients on the waiting list. She said she had faced many delays in her treatment. “I’ve had three recurrences of cancer and I need to have radiation six weeks after my surgery, which they failed to give me. I have pleaded with the MEC of Health and the Chief Executive Officer at Charlotte Maxeke to speed up the process so I can get my radiation but they failed.”

“I’m pleading: help us so we can get radiation to live a normal life with our family.”

Gauteng Department of Health spokesperson Motalatale Modiba said the department had received the memorandum and would respond to it. He acknowledged that there had been delays which he said were caused by tender processes.

“It is in our interest to ensure that we get to address the backlog of those that require treatment, and the department will formally respond to the concerns that have been raised.” He said a tender had been awarded.

“In May the process to treat patients will start in both hospitals.”

“The respective heads of oncology in Charlotte Maxeke and Steve Biko hospitals are busy with that process of onboarding.”

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : AgeingTags :

Old Age Grant is not Enough to Cover Care Needs, Researchers Find

On By ModernMedia
Photo by Thought Catalog on Unsplash

By Daniel Steyn for GroundUp

Researchers at the University of Cape Town (UCT) have found that in most cases, the Older Persons Grant is not sufficient to meet the needs of elderly people in South Africa.

Professor Elena Moore and other researchers from Family Caregiving, based in the Department of Sociology at UCT, interviewed 30 families in rural KwaZulu-Natal and 50 families in the Western Cape to find out how families headed by pensioners are making ends meet and whether older persons are able to get the care they need.

About 3.9 million people in South Africa receive the monthly Older Persons Grant, also known as the Old Age Grant, currently at R2080 per person per month.

Family Caregiving analysed data from Wave 5 of UCT’s National Income Dynamics Study (NIDS), which shows that the vast majority of beneficiaries live in households of five people where the average household income is R6850.

Older people have significant and unique care needs, the researchers argue. According to StatsSA data from 2021, the majority of older people need chronic medication and need to access healthcare facilities: 24% of older persons in South Africa have diabetes, 68% live with hypertension, and 14% have arthritis. Older people also often have difficulties with sight, mobility and cognition, meaning they need additional support to go about their day-to-day lives, say the researchers.

In a rural area in KwaZulu-Natal, Family Caregiving found that most households had between eight and nine members and were struggling to cover the cost of food, medical supplies, and transport to clinics.

In this area, accessing healthcare is expensive, the team found. A round trip to town by taxi cost R46 and a trip to the closest clinic and back costs R82. Physically disabled older people often have to hire a car for between R200 and R600 to get to a clinic and back. A pack of adult incontinence products costs R219 and lasts only seven days.

Because of the costs of transport and medical supplies, many of these large households were spending an average of only R1000–R1500 a month on food, according to the report. A lack of access to water and electricity creates an additional burden for older people in rural areas.

In urban areas, such as Cape Town, there is greater access to water and electricity, health facilities are closer, and households are smaller, meaning the Older Persons Grant is not stretched as far. But still, the researchers found, older people are often required to carry households at the expense of their own care.

Low income and low-middle income families in Khayelitsha and Eerste River told the researchers that the only way to make ends meet is to spend less on food. Many families are stuck in debt cycles, borrowing from loan sharks from month-to-month with extremely high interest rates. Unpaid utility bills stack up, and electricity tariff hikes and rising rental prices put further pressure on older persons.

The monthly cost of nutritious food for a family of seven is R5324, according to Pietermaritzburg Economic Justice and Dignity’s household affordability index. Family Caregiving found that low-income households headed by older persons are often spending less than half that amount on food because of other household expenses. This has serious consequences for older people, especially those who need to eat before taking medication.

The report recommends additional investment by the government to care for older people, such as free transport to health facilities and consistent supply of incontinence products.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp