BHEKISISA | How a badly run municipality led to a health centre having to halve its operating hours

A rural Eastern Cape health centre has had to close its doors at night because of crime and dry taps. But the municipality, police and provincial health department say they are not to blame.

It was only when she tried to run away to save herself that a former colleague of Sisipho Grootboom* discovered she was stuck. 

Her patient’s family, who’d rushed him in intoxicated and with a knife wound, had locked the main entrance, fearing the attackers would try to get to him again.

However, in doing so, they cut her off from the only other person on site, and the person who could help her most, the security guard. 

It was 2022 and Grootboom, a professional nurse, worked at Ngcobo Community Health Centre in Masonwabe township, about 80km from Mthatha in rural Eastern Cape.

Her nursing colleague hid in a side room. The security guard, who’d heard the commotion, managed to find his way into the building to battle with the aggressive patient. 

During her 20 years as a nurse, Grootboom said she’s never experienced anything like what happened to her colleague on that night at her workplace.

She has become used to dealing with unequipped and understaffed health facilities, and how to find ways around it to serve her patients. 

However, fearing for their lives has never been part of her worries in the way it is in Ngcobo.   

No water, no service

Not feeling safe is part of what led to the 24-hour community health centre, which serves about 3,000 people every month according to the facility’s manager Ncandeka Sotyato, being forced to cut its operating hours in half. 

About eight out of 10 people in the town live in poverty and rely on public health facilities. 

The health centre, only open from 7am to 7pm and no longer attending to after-hours emergencies, is about 1.5km from the business centre in Ngcobo. This means there’s a constant thoroughfare of people, including patients coming to the clinic to collect chronic medication, have their children immunised, see a doctor, get an antenatal check-up or receive help for a medical emergency. 

A community health centre like the one in Ngcobo is an important cog in the country’s primary healthcare machine. They provide routine and emergency services 24-hours a day and can reduce the patient load in district hospitals, which are geared towards handling child health issues, reproductive health problems, more complex health matters and general surgeries.  

To function well, a health centre needs proper infrastructure, including easy access to running water, something the Ngcobo centre hasn’t had for the past 10 years, said Grootboom.

The two buildings that make up the facility have no piped water, said Sotyato. Water is supplied from municipality-serviced tanks outside. This means staff have to fetch water in plastic containers and carry them inside to flush toilets, wash hands and clean. 

Blame games

It’s here where the blame shifting starts. 

According to law, municipalities at town or district level are responsible for providing services including collecting rubbish and supplying electricity and water to people in the area. 

In the Chris Hani district, under which Ngcobo falls, only 20% of households have running water inside their homes. 

In the Engcobo subdistrict, things are even worse. Only about 7% of households can open a tap inside their home for water. 

Ngcobo’s mayor Siyabulela Zangqa said the council is “not a water service provider like the district municipality” and he is not notified about water delivery issues.  

However, the district’s mayor Lusanda Sizani told Bhekisisa water infrastructure “is the responsibility of the public works department, which, at the lowest level, is a provincial governance structure”. 

Bulelwa Ganyaza, spokesperson for the district municipality, claimed because funds for building or upgrading systems for services such as water supply, which come from municipal infrastructure grants handed out by the co-operative governance department, have dropped, “some projects have been delayed since 2012, affecting the provision of water and sanitation services to the town and informal settlements”. 

In the 2023 financial year, about half the roughly R328m available for water and sanitation projects in the Chris Hani district was set aside specifically for water supply infrastructure.

Clamping down on crime — not

While officials are passing the buck, it’s the people in the community who lose out. 

The situation at the clinic mirrors the collapse of other local government structures in the area. For example, crime is rampant. ISS Crime Hub statistics show crimes in categories that include murder, theft, assault and sexual offences have close to doubled in Ngcobo over the past 10 years.

The police deny they do not have a handle on crime. 

Eastern Cape police spokesperson Col Priscilla Naidu told Bhekisisa “police conduct frequent operations in the area”.

She cited, as an example of their success, that in a clampdown in March, “three suspects [in a community of about 155,000 people] were arrested (for possession of an unlicensed firearm, drug dealing and selling liquor without a licence)”.

Naidu said they started a 15-member community patrol group in March.

However, Zangqa said he’s seen how crime in the area has affected services, including the health centre.

“Crime got to the point where it started affecting the clinic.”

The nearby tavern, which is open 24-hours a day, is a problem, he said.

“The people who drink there at night cause chaos.” 

The lack of proper municipal services makes it worse.”

Stalemate

The incident in which the night-shift nurse was attacked in 2022 was the final straw for staff at the centre. The nurses reported the attack to their union, who wrote a letter to the Eastern Cape health department, Grootboom told Bhekisisa.

In the letter, the union put forward concerns about safety issues and the conditions at the health centre under which staff work. 

In response to Bhekisisa’s inquiry about the implications of the issues at the health centre, health department spokesperson Mkhululi Ndamase said when healthcare workers are too traumatised or afraid to work, it “impacts negatively on service delivery and communities end up suffering”. 

Grootboom said: “At night it’s very scary to fetch water from the tank since safety in the area is so poor. The security guards don’t have guns and there are only two of them so I’m not sure how they will protect us if there are many attackers.”

The department and unions continue with talks, Ndamase said, and “we are hopeful a lasting solution will be found and the labour matter resolved”. 

Until the stalemate breaks, the health centre remains closed after 7pm.  

Many years, no change

For the past 30 years, or since the first democratic elections, the ANC has been in charge of the Eastern Cape’s affairs. 

A report issued by human rights organisation Section27 20 years ago looked into why healthcare delivery is so poor in the province. It found many facilities didn’t have a reliable supply of electricity and water, many were too small for the number of patients they serve and “some were literally falling apart”. Section 27 said this was the culmination of a systematic breakdown of health services over 15 years and needed “urgent attention”. 

“We call on the MEC for health to develop a plan with clear time frames that include components that address the items listed urgently to remedy the crisis in health in the Eastern Cape,” it wrote.

Nearly 10 years later  little had changed. 

A 2021 public protector report found at four district or provincial hospitals buildings were run down, services like water and electricity were lacking, facilities were understaffed and equipment was either so old or non-existent that basic tasks like washing laundry couldn’t be done on the premises. 

In another report last year, which looked into the state of health services, basic education and infrastructure development in villages across the Eastern Cape, the independent watchdog found many government buildings, including clinics, didn’t have a proper water supply, pipes were damaged, roofs were leaking and toilet facilities were inadequate. 

The lack of maintenance was laid at the feet of the provincial public works department, which should, but has failed to, inspect public facilities every five years and do the necessary maintenance for the facilities to deliver proper services.

In last month’s elections close to two-thirds of Eastern Cape residents voted for the ANC, which has been in charge for 30 years. 

Will new public servants serve their public this time?

In 20 years, Grootboom hasn’t seen change.  

“When we complain about water, we’re told to speak to the district. Then we’re told to speak to public works. We go back and forth, but we still end up with no water. If you’re not on the ground, it’s impossible to understand our challenges.”

*Not her real name

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.