We are aware that this is going to be a tight budget and dividing the pie a challenge for minister Gordhan. It is therefore more important than ever to recognise work that is being done well and form meaningful partnerships with non-governmental organisations (NGOs) which are serving society in ways that strengthen service delivery.
 
Suggestions to achieve this:

• Contracts with NGOs to be for at least three years instead of all the time and resources spent negotiating single year agreements. This would allow more time to be spent on monitoring that deliverables are happening according to the contract;
• Clarify lines of communication. Our health and welfare forum functions well, but the official channel to the Department of Health is the district health council, which is not effective and the district AIDS council which does not exist;
• The intervals of invitations to submit proposals to the National Lottery Distribution Trust Fund (NLTDF) are growing ever longer; and
• Until the government departments tasked with delivering services can do so alone, government should budget realistically to support the NGOs which work effectively to improve the lives of South Africans.

Some of the challenges currently faced by our hospice:

• Contracts with NGOs to employ community care workers make provision for half-day contracts with very low stipends. These people are committed, highly skilled and able to place the care delivered in the appropriate cultural context. More job security and financial compensation is urgently needed;
• Health sector funding from local corporates and offshore funders such as the
• President’s Emergency Plan for AIDS Relief (PEPFAR) is being scaled down as a result of (among other reasons)
  • Education being funded as a first choice;
  • The belief that the HIV epidemic is adequately addressed and resourced by the Department of Health; and
  • Funding being directed to the Department of Health and the National Health Insurance.

• A recent study published in the South African Medical Journal (SAMJ February 2014 Vol 104, No 2 p. 119-1230) revealed that the burden of pain and symptoms increases with the length of time on antiretroviral drugs (ARVs), with the mean number of symptoms (physical and psychological) being 10 in people who had been on treatment for an average of three years. Another article in the same journal (p.138-141) examined the palliative care needs of patients in public hospitals. 54.8 percent of patients in general medical wards were found to have palliative care needs.

Janet Stanford
Chief Executive Officer and Medical Director
Knysna Hospice
Tel: +27 44 384 0593
Fax: +27 44 384 0456
E-mail: janet@hospiceknysna.org.za
 
For more about the Knysna Hospice, refer to www.hospiceknysna.org.za.