Seven hundred mental patients in the Eastern Cape are at risk, with the Life Esidimeni facility in Kirkwood facing closure after its contract was only extended to December.
The decision not to renew the contract flies in the face of several warnings that the nongovernmental sector in the province does not have the capacity or training to care for most of the patients.
It follows the distressing Life Esidimeni saga in 2017 when 144 psychiatric patients died after the Gauteng health department terminated its contract with the Life Esidimeni group in that province and moved the patients to illequipped NGOs.
The Eastern Cape health department’s contract with Life Esidimeni Kirkwood expires at the end of September and officials have only agreed to extend it for three months while they “test the market”.
Life Esidimeni says it has not been told yet that the contract will not be renewed.
The decision comes days after health ombudsman Prof Malegapuru Makgoba asked health minister Aaron Motsoaledi to appoint an administrator to oversee mental health in the Eastern Cape.
He said the department had clearly demonstrated time and again that it was “incapable of recovering or correcting by itself and without the assistance of an external tough task master or administrator”.
It had failed to implement its plans on mental health services and “also seemed incapable of action or implementation over long periods and failed to develop communitybased mental health services”.
Provincial health spokesperson Lwandile Sicwetsha said the contract for the Life Esidimeni Kirkwood Care Centre would expire on September 30 and had been extended for three months only while the department tested the market.
The department pays about R10,000 a patient a month at present.
The decision also contradicts former health MEC Pumza Dyantyi’s statement to parliament in 2017, when she said: “There is currently no intention to stop the contract, which is renewable, based on performance, every three years for a 15-year term.”
She said there were only two licensed non-government organisations in the province that had been approved to take care of the chronically mentally ill and that they only had a total of 70 beds between them.
Dyantyi told the MPs the plan to keep the Life Esidimeni contract going was to “build capacity” in the province’s NGO sector.
Sicwetsha said he could not comment on whether the skills and capabilities existed in the Eastern Cape for patients to be moved into community healthcare.
“The department is unable to provide a response at this stage as it is in the process to test the market to find a capable supplier for the service,” he said.
Sicwetsha said the tender for the service would be advertised before the end of the year.
“As a department, we are driven by supply chain management policies and regulations,” he said.
“Hence we are testing the market to find if there are any appropriate responses.”
He did not respond to a question about the U-turn on Dyantyi’s recommendation that the Kirkwood contract be renewed every three years for the next 15 years.
“The department is processing for a new bid for the provision of chronic mental health services, persons with severe mental health and disabilities and community-based rehabilitation services,” he said.
Life Esidimeni managing director Puseletso Jaure said no notification had been received that the contract would not be renewed.
“The contract term is October 1 2015 to September 30 2018, with an option to extend,” she said.
On August 14, a report was tabled in the Eastern Cape Legislature by a special oversight committee assembled by the office of premier Phumulo Masualle asking for the urgent finalisation of the contract with Life Esidimeni.
The committee members asked Masualle to ensure that the extension of the contract “is handled with the care and urgency it deserves”.
They also recommended that the office of the premier ensure that the health and treasury departments had budgeted accordingly for a 19% increase in psychiatric drugs.
They commented on how well the patients at the facility were being looked after.
The committee member also requested that the coverage of the long-term facility be extended to the Alfred Nzo district, where there are no mental health services.
Masualle’s spokesperson Sizwe Kupelo said they had still not seen the report.
The provincial health department recently removed patients from a private, unlicensed mental healthcare facility in Butterworth where they were sleeping in a warehouse and had no access to medicine or rehabilitation services.
These patients were sent to Life Esidimeni in Kirkwood.
According to the report presented to parliament by Dyantyi, the province needs a further 1,220 beds for patients with chronic mental conditions to comply with national health standards.
The Life Esidimeni tragedy in Gauteng was described by Makgoba as “Project Marathon”, which was done in a “hurry/rush”, with “chaotic” execution, in an environment with no developed culture of primary mental healthcare community-based service framework and infrastructure.
In a recent report into the state of Tower Hospital in Fort Beaufort, Makgoba was scathing about the way the Eastern Cape health department had handled mental healthcare, asking the minister of health to appoint an administrator to oversee this aspect of healthcare and also for a review of legislation that was making it impossible for the president, Motsoaledi or magistrates to intervene in the mental health system.
Social development provincial spokesperson Mzukisi Solani confirmed that Life Esidimeni was still providing frail care to patients at the only two fully funded frail care centres in the province – Life Esidimeni Lorraine and Life Esidimeni Algoa.
The department took a decision not to renew the contract for the care of these patients in 2016 but was stopped by a court order from removing patients elsewhere without the permission of a judge.
The department has been looking unsuccessfully for two years for an NGO to take over the contract.
Solani said a steering committee had been appointed and a feasibility study was under way to establish whether the department could run a state-owned frail care centre in Port Elizabeth.