19 MAY 2021

HEALTH CARE SERVICES IN

CORRECTIONAL CENTRES
INCLUDING SERVICES &
TREATMENT OF STATE
PATIENTS
 PRESENTATION OUTLINE
1. Purpose
2. Background
3. Problem Statement
4. Services rendered and treatment of State Patients (SPs) awaiting transfer
5. Number of SPs transferred to designated Mental Health Institutions
6. Status of SPs as at 10 May 2021
7. Number of Mental Health Care Users
8. Challenges on the transfer SPs
9. Mitigation Interventions on the transfer of SPs
10. Suggested wayforward/Recommendations
11. Mandate of Incarcerations and Corrections
12. Mandate of Health Care Services
13. Health Care Services Capacity: Human Resources (HR) Head Office and Regions
14. Health care professional-inmate ratios
15. Health Care Services Capacity: Facilities
16. Health Care Services Capacity: Budget Allocation
17. Health Care Services Capacity: HR Challenges and Mitigation Interventions
18. Health Care Services: Other Departmental Challenges and Mitigation
Interventions
19. Service Delivery Improvement Measures
20. Conclusion
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PURPOSE

To brief the Portfolio Committee on:

 The provision of Health Care Services in correctional
centres including services; and
 Treatment of State Patients in the Department of
Correctional Services (DCS).

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SERVICES & TREATMENT OF STATE PATIENTS

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BACKGROUND
The admission of State Patients (SPs) into correctional facilities is the
result of a court order issued in terms of section 77 of the Criminal
Procedure Act, 1977 (Act No 51 of 1977) as amended.

The Criminal Procedure Act, 1977 (Act No 51 of 1977) Section 77-79

Provides that “ a mentally ill person who committed a serious offence
should be admitted in the correctional centre due to unavailability of
beds at a designated mental health care institution” (Psychiatric
Hospital)

Arrested individuals are admitted into correctional facilities as

remanded by the court and included in this category of inmates are
those that are mental health care users, but have not been confirmed
as such by health care professionals and psychiatrists.

The accused may be referred from court to a psychiatric forensic unit

for a forensic psychiatric observation in terms of section 79 of the
Criminal Procedure Act, 1977 (No 51 of 1977).
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BACKGROUND
The assessor submits a report to court after 30 days upon which the
court declares the Remand Detainees as a State Patient and a charge
sheet and court order is issued.
 
• Section VI, subsection 42 of the Mental Health Care Act, 2002 (Act
17 of 2002) dictates that State Patients be transferred from a
correctional facility to a designated mental health care facility of
the DoH within 14 days of the release of the court order to the
Head of Correctional Centre.

• Upon receipt of the court order, the HCC must forward a copy of
the order in question to the head of the national department
within 14 days, requesting that the State patient be transferred to
health designated mental health establishment.

• The head of the national department must immediately after

receipt of the order- issue MHCA 23 form which clearly determine
the health establishment State patient must be admitted.
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BACKGROUND

• In administering this process through the Justice Crime Prevention

and Safety Cluster, a state patients protocol in the context of a
process to review the criminal justice system was signed by
Accounting Officers of the Criminal Justice System departments
and the Accounting Officer of the DoH in 2016, making provision
for keeping of state patients beyond 14 days in cases where the
DoH cannot confirm availability of beds.

• The protocol is in line with the Criminal Procedure Act as

Amended.

• The department of correctional services processes transfers of

State Patients to designated Mental Health Care facilities as per
legislation upon availability of bed space from the department of
health.

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BACKGROUND
The number of declared State Patients (SPs) in the country continues to
increase due to the increase in Mental Health Care Users globally, which
will be further worsened by the global pandemic of COVID-19 and other
effects of Communicable Diseases especially HIV and AIDS.

As at 10 May 2021, there were 123 State Patients in DCS facilities, with
Free State Province recording the highest number at 33, followed by
Eastern Cape at 31 and Mpumalanga at 24. However this is an
improvement from captured statistics as at July 2020 as the number of
state patients in DCS facilities was 198 with the Eastern Cape Province
recording the highest number at 91 followed by Free State at 37 and
KwaZulu-Natal at 24.

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PROBLEM STATEMENT
The Heath Care System in South Africa is unable to cope with the
continuous increase in the number of declared State Patients in the
country due to the following:

• Inadequate number of designated Department of Health Mental

Health Institutions as required by the Mental Healthcare Act, 2002
(17 of 2002);
• Non availability of beds in the designated Mental Health
Institutions due to an increase in demand.

As a result, State Patients remain in DCS’ care beyond 14 day. This has
an impact on DCS resource allocation and utilization as the
department continues to ensure that state patients receive the
expected standard of health care services as they await availability of
beds in designated DoH Mental Health Institutions.

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SERVICES RENDERED AND TREATMENT
OF SPs AWAITING TRANSFER
In line with its mandate the Department of Correctional Services
renders the following services to State Patients as they await transfers
to designated Mental Health Institutions:

• Orientation, assessment, diagnosis, treatment, on-going care

(counseling), rehabilitation and referral (for common diseases) of all
mental health care users including periodic reviews, counseling and
support services;
• Tailored interventions for specific needs of individuals in line with
the diagnosis;
• Provision and administration of prescribed medication;
• Monthly follow up and assessments.

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 NUMBER OF STATE PATIENTS TRANSFERRED TO
DESIGNATED MENTAL HEALTH INSTITUTIONS -
30 OCTOBER 2020 TO 10 MAY 2021
PROVINCE NUMBER TRANSFERRED DATE OF LAST TRANSFER
Eastern Cape 74 10 May 2021

Free State 33 14 April 2021

Gauteng 18 14 April 2021

KwaZulu-Natal 25 30 April 2021

Limpopo 02 19 January 2021

Mpumalanga 00 00

Northern Cape 02 30 October 2020

North West 00 00
Western Cape 00 00

National Total 154

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 STATUS OF SPs AS AT 10 MAY 2021
  PROVINCE NUMBER OF STATE PATIENTS
Eastern Cape 31

Free State 33

Gauteng 08

KwaZulu-Natal 12

Limpopo 02

Mpumalanga 24

Northern Cape 11

North West 02

Western Cape No State Patients in DCS

National Total 123

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 STATUS OF MENTAL HEALTH CARE USERS
AS AT 31 MARCH 2021
The table below depicts all identified mental health care users on
  treatment within DCS . This is a person receiving care, treatment and
rehabilitation services aimed at enhancing their mental health status.

REGION NUMBER OF MENTAL HEALTH

CARE USERS
Eastern Cape 476
Free State/Northern Cape 640
Gauteng 1455
KwaZulu-Natal 565
Limpopo/Mpumalanga/North 724
West
Western Cape 830
National Total 4 690
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CHALLENGES ON THE TRANSFER SPs
• Difficulties are experienced when implementing inter-provincial
transfer of SPs with SAPS being responsible for transportation of
state Patients without the expertise to care for the Mental Health
Care Users over long distances. Reluctance of SAPS to transport
these patients out of DCS facilities result in SPs staying in DCS longer
than necessary;

• The Gauteng Province admits long term Mental Health Care Users
at Sterkfontein and Weskoppies limiting admission capacity for DCS
confirmed State Patients due to non availability of beds. Long term
Mental Health Care Users are individuals who are unlikely to be
discharged as compared to those who can be rehabilitated and
controlled on treatment within a shorter time;

• The SPs transfer from Mpumalanga Province is very slow as they

rely on the Gauteng Province’s designated Mental Health
Institutions.
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CHALLENGES ON THE TRANSFER SPs
CONT.…
• Despite the transfer of SPs to the designated Mental Health
Institutions, the number of State Patients does not decrease
significantly as there are new admissions regularly (For example the
Free State province discharged 30 SPs and admitted 26 SPs for the
period July 2020 – February 2021);

• The impact of COVID-19 led to the DoH having to repurpose some of

the bed space to accommodate COVID-19 quarantine and isolation
sites which further reduced the capacity to admit SPs;

• Increased pressure on existing resources as SPs could not move to

the DoH facilities;

• Focus shifted to COVID-19 at the expense of other priority health

conditions and programmes.
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MITIGATION INTERVENTIONS ON THE
TRANSFER SPs
Collaborative engagements between DCS and National Department of
Health produced the following interventions that are currently being
implemented to improve efficiency in the transfer of SPs from
Correctional Centres to designated Mental Health Institutions:

• DCS Centres avails the audio-visual facilities for presentation of SPs

to the DoH Psychiatrist to ensure that State Patients within DCS
facilities continue to receive the required care whilst waiting for
transfer to the designated Mental Health Institutions;

• Devised tools to ensure comprehensive and consistent

management of SPs within DCS facilities; &

• DCS avails the COVID-19 PCR results of less than 72 hours prior to
transfer of SPs.

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 SUGGESTED
WAYFORWARD/RECOMMENDATIONS
• The proposed way forward in the medium to long term in
line with the process to review the criminal justice system, is
to expunge the availability of bed space condition for
Transfer of State Patients in the Criminal Procedure Act so
that upon court order issue, State Patients be taken directly
to Mental Health Care facilities;

• In the short term, the Accounting Officers of Criminal Justice

Departments and Health should work together with the
Social Cluster to ensure that DoH designates more Mental
Health Care Institutions and also provide additional beds.

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 HEALTH CARE SERVICES AS PART OF
INCARCERATION AND CORRECTIONS

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 MANDATE OF INCARCERATION AND
CORRECTIONS
• Incarceration and corrections is mandated by, amongst others, the
following legislations that are aligned to the new strategic direction of
the DCS:
 Constitution of the Republic of South Africa, Act 108 of 1996
 Correctional Services Act, 1998 (Act No 111 of 1998)
 Criminal Procedure Act, 1977 (Act No 51 of 1977)
 Probation Services Act, 1991 (Act 116 of 1991)
 White Paper on Corrections of 2005
 All other applicable legislation, regulations and guidelines related to
Incarceration and Corrections
• Incarceration and Corrections is responsible for the provision of
detention conditions that are safe and secure whilst observing human
dignity by providing amongst others accommodation, nutrition and
medical treatment at state expense. 19
 MANDATE OF INCARCERATION AND
CORRECTIONS CONT. …..
The objectives of Incarceration and Corrections are amongst others is to:

• Ensure the provision, maintenance and enhancement of

effective offender administration with regard to personal
corrections. (Programme Incarceration).
• Ensure the provision, maintenance and enhancement of
rehabilitation through personal development programmes
(Programme Rehabilitation).
• Ensure the provision, maintenance and enhancement of
health care services, programmes and projects (Programme
Care)

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 MANDATE OF HEALTH CARE SERVICES
Core Functions of Health Care Service

Develop national policies to ensure access and provision of health care services in
accordance with all applicable international and national legislation, policies,
guidelines, standards and protocols, and in partnership and cooperation with
internal and external stakeholders.
Primary Health Care (PHC) Nutritional Services Personal Hygiene Services Pharmaceutical HIV and AIDS
Services
Provision of Promotive, Facilitate the Ensure the provisioning Ensure the
preventive, curative, implementation and and maintenance of Ensure the provision of
palliative care, referral and maintenance of food bedding, clothing and management of prevention,
rehabilitative services hygiene and safety toiletry to the inmates. hygiene in housing care, support
standards for the cells, sanitary facilities and treatment
transportation, and courtyards. programs and
preparation, storage of services to
food items and serving mitigate the
of food. impact of
HIV/AIDS.

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 HEALTH CARE SERVICES CAPACITY AT HEAD
OFFICE
Human Resources
MEDICAL PHARMACISTS ENVIRONMENTAL PROFESSIONAL OTHER (SOCIAL CUSTODIAL
PRACTITIONERS HEALTH PRACTITIONERS NURSES WORKERS)

HEAD Filled Vacant Filled Vacant Filled Vacant Filled Vacant Filled Vacant Filled Vacant
OFFICE
0 0 01 0 02 0 5 4 1 1 3 1

TOTAL 0 0 01 0 02 0 5 4 1 1 3 1

NB! Medical Practitioner temporary placed for clinical services

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 HEALTH CARE SERVICES CAPACITY IN
REGIONS
Human Resources
Region MEDICAL PHARMACISTS PHARMACIST PROFESSIONAL NURSES
PRACTITIONERS ASSISTANTS

Filled Vacant Filled Vacant Filled Vacant Frozen Filled Vacant *CNP Frozen

Eastern Cape 02 0 05 0 03 01 0 131 14 75 0

FS & NC 03 0 04 0 0 01 0 104 40 57 0

Gauteng 01 01 13 0 02 03 03 217 21 90 08

KwaZulu- 01 02 03 0 0 0 0 145 43 64 0
Natal

LMN 02 03 06 0 02 0 0 130 21 74 0

Western 03 0 05 0 02 0 0 131 36 70 0
Cape

TOTAL 12 06 34 0 09 05 03 858 175 430 08

*Clinical Nurse Practitioner

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 HEALTH CARE PROFESSIONAL-INMATE
RATIOS (INMATE POPULATION AS AT
01.04.2021)
Region Medical Practitioners Pharmacists Professional Nurses
(WHO norm 1:1000) (WHO norm 1:2300) (WHO norm 1:500)

Eastern Cape 1: 9481 1: 3792 1: 145

FS & NC 1: 6409 1: 4807 1: 185

Gauteng 0: 33007 1: 2539 1: 152

KwaZulu-Natal 1: 11172 1: 7448 1: 154

LMN 1: 7255 1: 3627 1: 167

Western Cape 1: 8547 1: 5069 1: 196

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 HEALTH CARE SERVICES CAPACITY:
FACILITIES
Clinics and in-patient Pharmacies Food service units
facilities
46 Management 24 Management Area 227 food service units
Areas with one in- pharmacies registered responsible for the
patient facility (per with the South provision of meals
management area) African Pharmacy across 243
Council (SAPC) Correctional Centres.
243 Correctional providing
Centres with one pharmaceutical
Primary Health Care services to all 243
(PHC) clinic each Correctional Centre
Clinics.

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 HEALTH CARE SERVICES CAPACITY: BUDGET
 
 
ALLOCATION
SUB-PROGRAMME 4: CARE BUDGET
ALLOCATION FOR 2021/2022 FY
PROGRAMMES BUDGET ALLOCATION
2019/2020 2020/21 2021/22
(R’000) (R’000) (R’000)
Nutritional Services 1 437 480 1 258 379 1 379 327
Health and Hygiene
1 007 102 1 385 235 1 161 591
Services
Total Budget National 2 444 582 2 643 614 2 540 918
• The average growth rate of this programme from 2016/17 to
2019/20 was 3.0% and is expected to grow from the
2019/20 adjusted appropriation to 2022/23 by 2.7%.
• The nutritional, health and hygiene services are funded from the
Care programme.
• The Department will continue to collaborate with partners to
ensure that inmates receive comprehensive health and
hygiene services during their period of incarceration. 26
 HEALTH CARE SERVICES CAPACITY
Human Resources Challenges

• The current departmental structure does not make provision

for other categories of health care professionals (Dietitians,
Food Service Managers, Environmental Health Practitioners,
Enrolled Nurses, Nursing Assistants, Data Capturers and
Counsellors etc.);
• Limited posts for permanent Doctors, Pharmacists and
Pharmacist Assistants (despite provision made in the
structure);
• Unavailability of Environmental Hygiene Practitioners (only 2
posts at Head Office);
• Inability to retain PHC trained nurses.

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 HEALTH CARE SERVICES CAPACITY
Human Resources Short term
additional capacity mitigation
measures
• The department was allocated 60
Community Service Pharmacists for 2021
(14 GP, 11 WC, 12 LMN, 8 FSNC, 9 KZN
and 6 EC).
• Gauteng Region has 18 Medical
Practitioners’ posts additional to the
establishment, although 13 are currently
vacant (the recruitment process is
underway).
• Some of the Regions have sessional
Medical Practitioners, Psychiatrists and
Dentists.
Human Resources Long Term capacity
mitigation measures
• The department is in a process to
review its organisational structure
and staff establishment and Health
Care services is considered a
mandatory priority.
• MoU with relevant partners such as
TB HIV Care and South African
Partners is in place.
• Collaboration with the DoH at all
levels
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 HEALTH CARE SERVICES: OTHER DEPARTMENTAL
CHALLENGES AND MITIGATION INTERVENTIONS
AREA CHALLENGE
Facilities • Poor maintenance of
infrastructure e.g.
o dilapidated food service
units
• Lack of dedicated heavy duty
laundry facilities (maintenance
of hygiene)
MITIGATING INTERVENTIONS
• During the 2019/2020 FY
the department
commenced with an in-
house pilot project for the
refurbishment of kitchens
as part of the own
resources programme.
Subsequently the three (3)
kitchens at the St Albans
MA were refurbished.
• In-house refurbishment
projects are scheduled at
the Mthatha and Sada
MA’s for the 2021/2022 FY.
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 HEALTH CARE SERVICES : OTHER DEPARTMENTAL
CHALLENGES AND MITIGATION INTERVENTIONS CONT. …
AREA CHALLENGE MITIGATING INTERVENTIONS
• Various kitchen refurbishment
projects (Groenpunt, Thohoyandou)
are funded and registered with
DPWI.
• A laundry was constructed at
George as part of the own resources
programme.
• The procurement strategy is
diversified through the use of
implementing agents as well as own
resources projects

Finance and Insufficient funds to fast • Implement staggered approach to

Supply Chain track establishment of establish pharmacies
Management pharmacies in Management • Various pharmacies were designed
Areas that do not have and constructed in-house, such as at
Barberton, Thohoyandou and
Southern Cape Management area.

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 HEALTH CARE SERVICES: OTHER DEPARTMENTAL
CHALLENGES AND MITIGATION INTERVENTIONS
CONT. …
AREA CHALLENGE MITIGATING INTERVENTIONS
• The own resources project for the
construction of a pharmacy at
Rooigrond is under way.
• The in-house design for a pharmacy
at Colesberg has been finalised, and
ready for construction.

GITO • Unavailability of health and • Implementation of telemedicine in

pharmacy systems resulting in correctional facilities.
unreliable data elements and • Telecommunications infrastructure
difficulty in conducting for online/ virtual eHealth
disease surveillance and stock consultations with health care
management practitioners.
• Inadequate ICT infrastructure • Finalize pending sign-off with SOE’s
to ensure infrastructure connectivity
for virtual consultation with health
care practitioners.

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HEALTH CARE SERVICES CAPACITY: OTHER
DEPARTMENTAL CHALLENGES AND MITIGATION
INTERVENTIONS CONT. …

The Department continues efforts to modernize its correctional

systems and overcome the challenge of unintegrated and non-
interoperable Information Systems. Digital transformation will be
prioritized in line with the 4th industrial revolution, in the automation
of business processes, the Master Information Systems and Security
Technology Plan (MISSTP) in relation to the Department’s Vision 2068

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 SERVICE DELIVERY IMPROVEMENT
MEASURES
• Establishment of Pharmacies in all Management Areas to improve access to
medicines;

• Assignment of Community Service Pharmacists (CSPs) to project “Adopt a clinic” in

line with the Ideal Clinic Model for improved pharmaceutical and overall health
service delivery;

• Collaboration with National and Provincial Departments of Health (including

placements of State Patients in Mental Health Institutions);

• Maintenance of Pharmaceutical and Therapeutics Committees (PTCs) as formal

governance structures in line with the Pharmacy Act 53 of 1974, National Drug
Policy, 1996 and Good Pharmacy Practice;

• Maintenance of Infection Prevention and Control (IPC) committees to improve

hygiene standards and limit transmission of diseases; &

• Maintenance of Health and Psychosocial Clinical Monitoring Team (HPCMT) to

enhance integrated/comprehensive service provision.
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CONCLUSION
Despite stated challenges with regards to resources for health
as well as the impact of COVID-19, there is concerted effort to
ensure provision of quality health care services to the inmate
population and the transfer of the state Patients from DCS to
the DoH.

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Thank You

Thank You

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