SPOTLIGHT: For these patients, the future is not a game – it is a matter of life and death (Part 1)

A patient transfer process in Limpopo that has been marred in controversy and legal wrangling has put the well-being of 3,774 patients at risk and raised questions about the provincial Department of Health’s commitment to patients.

On 9 July the last trickle of patients receiving ARVs and TB medicines at Ndlovu Care Group (NCG) arrived to collect their medicines at the facility for the final time. They were also handed transfer letters to be redirected from the not for profit facility in the township of Elandsdoorn, in Moutse, to state-run facilities. More than 3,700 patients have gone through a similar process over the last three months.

On paper it should have been a straight-forward transfer as result of a three-year contract between the Limpopo Department of Health (DoH) and NCG, a registered public benefit NPO, coming to an end. Instead patients sought to interdict the Department of Health and NCG for failing to reach an agreement to renew the contract.

The first approach to court by a group of patients ended without a hearing. The parties agreed to an order requiring Limpopo DoH and NCG to agree to a three-month extension of the contract between them, together with a joint implementation plan for the transfer of patients out of NCG (the extension had already been discussed by DoH and NCG before the litigation).



The plan required the Limpopo DoH to source the assistance of the Office of Health Standards and Compliance (OHSC) to assist with the assessment of facilities to which patients would be transferred; and required reporting on the implementation of the plan for the transfer of patients to be made available to the applicants by 2 July 2018.

The Limpopo DoH and NCG signed the agreement for three additional months, during which time patients were transferred to public facilities. NCG produced a report from its perspective which it provided to the applicants by 2 July 2018. Despite requesting input from the DoH on this report, such input was never provided.

The transfer has been marked by angry community protests and sparked accusations of racism, intimidation, arrogance and lack of transparency and communication.

The South African Human Rights Commission (SARHC) has stepped in to monitor the transfer process and both SECTION27 and the Treatment Action Campaign (TAC) have also become involved. SECTION27 supported Ndlovu Care Group as their legal representatives.

SECTION27’s Sasha Stevenson says Ndlovu has a good track record of high-quality care for the community. “The two parties to a contract are entitled to decide whether to renew that contract when it expires,” she says. “But more important is the right of people receiving health services to continue to receive those services and for the quality of those services not to decline. And the quality of services at NCG was high.”

The TAC has conducted its own clinic visits to ensure that patients don’t fall through the cracks and they will continue to monitor the clinics over the next few months. TAC however, is waiting for the Limpopo DoH to provide information of existing ART patient numbers at facilities so a baseline for future comparisons can be established.

The SAHRC’s province-wide investigations are a result of what it says is “the extremely concerning status of service delivery to members of the public seeking assistance from public healthcare facilities”.

The SAHRC however, has itself become the target of inflammatory tweets by the Limpopo DoH that accused the Commission of “blatant lies” over findings from a surprise SAHRC visit to Polokwane (Pietersburg) Hospital in mid-June. The SAHRC reported that expired food and medicines were being given to patients there.

MEC for Health Dr Phophi Ramathuba’s recent tweets and public comments about among others HIV/Aids being a black disease and intimating that people with HIV/Aids have themselves to blame for becoming infected have been widely condemned. Ramathuba faces being hauled to the Equality Court for these utterances. Her department was also made to apologise to the SAHRC.

SAHRC commissioner in Limpopo Victor Mavhidula says the legal intervention has been deeply polarising. Mavhidula says he understands how discrepancies and allegations brought to their attention may have impacted on the DoH’s decision not to renew. He points out that there are issues like clarity over the exact value of the contract; clear separation of revenue streams for running different operations at Ndlovu and reporting protocols for research findings at their on-site research facility.

Mavhidula however, says that the goal now is to ensure that patients are accounted for and do not end up defaulting on treatment or having their health compromised.

He adds: “It doesn’t matter where you want to receive your medicine, it’s your right to get treatment wherever you are in South Africa and the SAHRC reserves the right to monitor the transfer over the next few months.”

This comment flies in the face of the prevailing argument that Limpopo DoH funds should not benefit clients from outside the province.

All the fighting and the post mortems of the Ndlovu contract ending are pointless for Michael Mampuru and his wife Colet. Both were clients at Limpopo’s Ndlovu, receiving ARV treatment and care there.

“They are sending me to those other clinics to die,” says Michael. He’s a hulk of a man at 55 but remembers a time when he was almost defeated by HIV. He credits his recovery and good health today to the care he received at Ndlovu.

“When I came here in 2014, my wife held me up on one side and my sister held me on the other side, I couldn’t stand. I slept here for two weeks, they looked after me, they fed me and I got healthy.

“I don’t know what we will find that side. The government doesn’t care about us; I think we voted for them to kill us,” says Michael in Afrikaans and Sepedi.

He and Colet recount their experiences seated at wooden patio benches and tables. This is the patient overflow waiting area. It is spotless. It is also meant to be functional and patient-friendly. These little things, says Colet and Michael, made all the difference to their care at Ndlovu.

“They check everything nicely here, they do my Pap smear every year even when I forget and they know if you are drinking your pills properly because they talk to you– and we pay nothing,” she says.

Ndlovu does have other noteworthy features like a biometric patient identification system for better data capturing, record keeping and queue management. The facility reports that it’s never run out of medicines because of good stock management, they have private consulting rooms, equipment that works and adequate staffing.

The entire township of Elandsdoorn has an undeniable Ndlovu footprint. Over the years NCG set up a crèche, a children’s choir, a gym, a theatre and attractive accommodation meant to attract doctors and specialists to this remote part of the province.

With the non-renewal of the state contract however, 28 people at Ndlovu were retrenched in July. It’s raised fears about Ndlovu’s immediate viability as an employer and anchor in the area where there are already few jobs.

Dr Hugo Tempelman, Ndlovu Care Group, Elandsdoorn. Photo: Rian Horn