EC controversy over motorbike ambulances and clinics

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Are they “glorified wheelbarrows” or an “extremely innovative” solution to providing health services in the remotest parts of the Eastern Cape?

Controversy has been swirling around the province’s acquisition of 100 motorbikes with sidecars that were initially said to be for use to ferry patients. Now it appears they will be used for medicine distribution as mobile clinics.

 

Health Minister Zweli Mkhize has hit back at the Democratic Alliances (DAs) criticism of the Eastern Cape‘s controversial medical scooters which, according to Mkhize, were never intended to replace ambulances.

Polity reports that Mkhize’s response to DA MP Siviwe Gwarube’s written parliamentary question, revealed that the scooter project that the Eastern Cape Health Department launched, did not meet the basic criteria for patient transport as an ambulance. Instead, he said the purpose of the project was to widen access to primary health care and deliver chronic medicine in remote areas of the Eastern Cape.

Health MEC Sindiswa Gomba said the motorbikes would be used by health workers to reach far-flung areas where patients end up being neglected because of the road infrastructure.

 

Eastern Cape Health superintendent general Dr Thobile Mbengashe said the 100 scooters acquired by the provincial health department were never meant to be ambulances. And says a News24 report, he has defended the project calling it “extremely innovative”.  Mbengashe said there was a misunderstanding on what the scooters were intended for, adding that the National Health Act had strict regulations on what constituted an ambulance.

Mbengashe is quoted in News24 as saying the R10m tender was “definitely not a blunder”. “There was a demo of the capabilities of scooters in difficult areas. Those capabilities were very impressive in terms of demonstration of what the scooters could do,” he said.

The department confirmed that the Bid Adjudication Committee (BAC) was reviewing the processes followed in the awarding of the deal, News24 reported earlier. Mbengashe said this was an ordinary part of the department’s procurement procedure of due diligence.

 

DA statement on the issue:
In a reply to a parliamentary question posed by the Democratic Alliance (DA) on the suitability of the ‘Scooter Ambulances’ as a form of patient transport, the Minister of Health, Dr Zweli Mkhize, has confirmed that these scooters do not meet the basic Emergency Medical Services (EMS) regulations.

The reply goes on further to state that these R10m glorified wheelbarrows which have been procured with public money will only be used to deliver medication in rural parts of the Eastern Cape. This is in direct contradiction to what was said when the initiative was launched on the 12th of June where it was stated by the Eastern Cape Health MEC, Sindiswa Gompa, that these were meant to ferry patients from rural areas to the nearest health facilities.

Mkhize further confirms that the province did not consult the National Department of Health (NDOH) on the specifications of these scooters but have since been advised that the fall foul of the regulations governing patient transport.

This week, the Bid Adjudication Committee in the Eastern Cape committed to investigating the awarding of the tender to the supplier of these scooters. This is in addition to the investigation the DA has requested for from the South African Human Rights Commission (SAHRC) to look into the rights of patients who would have to be subjected to this inhumane transport.

The DA will submit this response from the Minister to the SAHRC as supplementary evidence in the investigation they have committed to doing.

If the NDOH now backtracks from the initial purported function of the scooters which Minister Mkhize personally endorsed, it begs the question why R10m is being spent of a chronic medication distribution system. What is the point of the first aid equipment, drip stands and the stretcher attached to the scooter?

This Scooter Scandal is yet another indication of the ineptitude of the Eastern Cape Health Department leadership. The MEC has recently argued that the department is bankrupt, yet R10m can be wasted on scooters which will gather dust in some warehouse. All the while, the province is failing to mount a decent response to the Covid-19 crisis. There is a critical shortage of staff, insufficient bed capacity ambulances in some areas, underscored by the rising number of infections and deaths.

The call for the Eastern Cape Health Department to be placed under administration in accordance with section 100 of the Constitution has become urgent. If Minister Mkhize does not act to operationally manage the province, there will be avoidable loss of lives.

Issued by Siviwe Gwarube, DA Shadow Minister of Health

 

Motorbike sidecar ambulances and clinics are one of the best things to come out of the Eastern Cape. Yet, writes Janette Bennett in a report on the Under The Milkwood site, certain quarters are trying their best to bludgeon the life out of this initiative that reaches into the heart of rural areas.

Bennett writes:
For the past 15 years, motorbike sidecar ambulances and clinics, manufactured in a Fabkomp factory in Zwelitsha outside King Williams Town in the Eastern Cape of South Africa, have been distributed and used throughout Africa and now in the Middle East and Asia.

The very first of these vehicles were launched at Nelson Mandela’s home in Qunu in the former Transkei Bantustan in the Eastern Cape in 2003. The sidecar ambulances and clinics have been used in small projects with non-governmental organisations in South Africa, but never took off on a big scale in the country.

It’s another story for African countries. Buyers and distributors include UNICEF (Uganda, Ethiopia, Sudan, Zambia, Liberia, Guinea, Zimbabwe, Sierra Leone), the Clinton Health Access Initiative (Zambia, Ethiopia, Malawi), the Salvation Army (Kenya), the United Nations Population Fund (Cameroon), USAID (Zambia), DFID (Malawi, Zambia, Zimbabwe, Kenya), Save the Children (Ethiopia, Philippines), UNDP (Tanzania), the Gates Foundation (Zambia, Zimbabwe) … I could go on, but that would fill this page and more. You get the picture.

Fabkomp has quietly gone about its business, supplying these markets from the Eastern Cape, as creaky as this province is. But when it won a tender to supply 100 motorbike clinics (note: not motorbike ambulances) to the Eastern Cape Health Department, the knives came out; so, did the hammers and axes. It became a feeding frenzy of sheer nastiness, apparently with an agenda or two involved.

It’s been more than disturbing. It’s been unethical in the extreme, in my view. However, my intention in this post is to tell the story, without a spin, because you are smart enough to make up your own mind about these vehicles and the debacle they’ve been plunged into.

I’ve broken it into chunks to make it easier to read and concluded it with a breakdown of costs because the price has drawn some of the loudest critics. I base the post on information that Fabkomp director Brian Harmse has made available to the media, my conversations with Brian, and my own research.

And the best way to tell a story such as this is to start at the beginning.

About Fabkomp and eRanger – Fabkomp, which makes components and other products for the automotive and engineering industries, has been in business for 37 years. About 160 people work in the Zwelitsha factory. These are good, solid jobs in South Africa’s “basket-case” Eastern Cape province, where unemployment is rife. Each year, it trains 48 Walter Sisulu University engineering students doing their P1 and P2. It also trains around 15 apprentices at any given time.

Brian bought Fabkomp in 2000 and implemented broad-based black economic empowerment shareholding: 60% is owned by DEmPower LD, which is black owned (100% are people with disabilities and 54.55% are women); and 40% is owned by Choice Decisions 52 (Pty) Ltd, of which Brian is the owner and MD.

Brian is also a director of eRanger (the Ranger Production Company), based in King William’s Town. Fabkomp owns 49% of eRanger and international shareholders own 51%. eRanger imports and exports units. Fabkomp sells to the South African market as it has the NaTIS certification from government to do so.

In 2003, Brian met eRanger MD and inventor Mike Norman. Mike was launching the first units in South Africa at Nelson Mandela’s home, and he was looking for a partner in South Africa. He found his partner: Fabkomp.

Putting it all together – eRanger imports the 200cc motorbikes in semi-knocked-down (SKD) form. It brings in full containers to maintain stock levels. “Not a single motorbike in South Africa is made from scratch,” Brian says. “We simply don’t have the volumes.”

When it receives an order, Fabkomp buys the bikes from eRanger. It then adapts and modifies the motorbikes and manufactures the steel structure and suspensions systems. This includes casting the sidecar wheel from aluminium in its own foundry. The bikes have to be adapted to be able to work with a sidecar in off-road conditions, including dirt roads in bad repair.

From the start, the partners wanted to be absolutely certain that the sidecars would cope with the road conditions. With the support of the Automotive Industry Development Centre, they were sent to Gerotek in Pretoria to undergo rigorous independent testing. “The idea was to see what would fail in the accelerated testing process,” Brian says. “We identified areas that needed improvement and these changes were then implemented. We are confident that these units will work well in South African conditions, just as they do in other projects in many countries in Africa.”

On the ground – I grew up in the Transkei and I return there, to its deep rural areas, whenever I can. The roads and tracks, for the main, are very poor. They literally cut people off from markets, from services – and from health facilities. Often, traditional ambulances (if they are available) cannot reach homes.

The benefits these motorcycles hold for such areas are a no-brainer. And there’s a well-tracked history that speaks for itself – reports from Uganda, South Sudan and Kenya show – these are all produced in the factory in Zwelitsha. The sidecar ambulance is the bigger seller. It is often used to move women who are having a difficult birth to the clinic.

Yet the motorcycle ambulances are actually not ambulances at all. They are intended to get people to a clinic or ambulance that will take them to a hospital or clinic. They are built for gravel (dirt) roads, not for tar.

So, they are not meant to replace ambulances, but they are meant to replace wheelbarrows for transporting people who need medical help. A photograph of a woman pulling a man in a wheelbarrow, on the front page of the Daily Dispatch in 2013, etched itself into Brian’s head. “We must do better than that. We must treat people better than that,” he says.

The Eastern Cape angle – The Eastern Cape interest in the motorcycle sidecar clinics came long before COVID-19 turned our world upside down. According to Brian, it’s been on the Eastern Cape Health’s budget for the past two years.

Fabkomp successfully tendered to supply 100 of the motorcycle sidecar clinics (tender number: SCMU3-20/21-0022-HO). It received a letter of award, but has not received the official order from the department, and nor has it received any payment. For 2.5 months during the lockdown, the Fabkomp factory did not operate and cashflow is tight.

Given the COVID-19 crisis – with the healthcare system breaking under the weight of the pandemic – Fabkomp plans to assemble 20 clinics. Once an order is received, the first 20 units will be supplied within a month. “We only have 85 motorcycles in stock and we’re waiting for the last 15 to arrive in SKD form. COVID-19 has created a delivery challenge. At this stage, we don’t know when they will land in South Africa.”

A chain of events – So, what happened? On Tuesday, 9 June, the department asked Fabkomp to showcase sidecar clinics on the East London Esplanade on Friday, 12 June. “We did not have any clinics ready and we told the department that we had only four ambulances completed,” Brian says. “We also had a demo of the ambulance unit and the clinic unit. We were then asked to have these six units available for the demo.” The four ambulances used at the demo are now on their way to Kenya.

The storm hit immediately. Various Facebook groups waved the flag of condemnation, too. People generally don’t like to break rank and be a lone voice of dissent, I saw. These, I think, are some of the key moments:
12 June: One of the very first tweets is from the EFF’s Mbuyiseni Ndlozi: “So instead of building roads in the Eastern Cape to access all villages and households, you went to buy scooter ambulances? Pathetic government of ANC is truly beyond repair….” The tweet was shared 899 times and got around 3,300 likes.
15 June: Jane Cowley, the DA Eastern Cape Shadow MEC for Health, who had been at the demo, releases a statement: “Patients are dying on floors in our state hospitals and frontline workers have the highest rate of COVID-19 infections in the country, and what does out MEC of Health, Sindiswa Gomba, do? [She] decided to launch the procurement of 100 1920’s-style scooters ….” She adds: “This entire Scootergate saga smacks of corruption!”
16 June: EFF leader Julius Malema threatens: “if they (the motorbikes) are found in the village claiming that they are coming to fetch a sick person, fighters you know what to do with such a behaviour … I will tell you in our space and privacy.”
Some time in the fray: A seller on Alibaba offers a sidecar unit for R17,000, using a picture lifted from the eRanger website. There is no link to a company or website. Nevertheless, tweets of the Alibaba offering are shared hundreds, possibly thousands, of times as proof of massive profiteering, corruption and selling of inferior products. So, who placed the picture on Alibaba and then disappeared?
19 June: The DA asks the SA Human Rights Commission to investigate the “Medical Motorbikes”, which “are not suitable for patient transport anywhere in the country, let alone in the rural Eastern Cape with little to no road infrastructure … This intervention by the Eastern Cape is denying access to healthcare and emergency care to those who will be confined to using this transport system.”
30 June: The Daily Maverick joins the now very frayed fray in a report about the shocking state of the health system, collapsing with COVID-19, in the Eastern Cape. “People are dying in the streets and mortuaries have run out of space,” it claims. Really? Reality is clearly not horrific enough. The reporter goes on: “… the most glaring example of wastage … must be the R10m spent on rickety scooters …”
This week: Brian learns that the Eastern Cape Department of Health has put the project on hold as the provincial health committee has raised questions about the tender. “The DA is asking the process to be checked out, which is fair,” Brian says. “We don’t have the order yet, only the letter of award, which we accepted. So we are happy with the process as we have done nothing wrong.”

I ask Brian where he thinks the outrage has come from and he points to political parties, notably the DA. Also, he thinks that South Africans, in general, are fed up with the corruption that has taken place and are convinced that every awarded tender is corrupt too.

Political point scoring and lack of trust in government makes sense. I think there is another reason: the motorbike sidecar ambulances and scooters are a useful symbol of all that is wrong in a province where there can be no good at all. A success story does not suit the narrative of people who have the need to point at other people and other places to make them feel that they’re not that bad off – and not that bad – themselves. It’s driven by fear – this scapegoating, this “othering” – and it is called stigmatisation.

The bottom line – So, what do these vehicles actually cost? There has been much outrage at the price tag. Brian points out that he has, from day one, offered to play open book costing with the media, the DA and anyone who wanted to talk to him.

This is his explanation:
Excluding VAT (the money that government takes in tax), a fully equipped clinic costs R82,250 and a sidecar ambulance costs R68,800.

In comparison, a traditional 4×4 vehicle ambulance would cost around R1m: like the sidecar ambulance, the traditional ambulance carries one patient. The cost breaks down like this:

eRanger costs for each motorcycle in South Africa
Motorcycle price (via eRanger) – R15,500
Shipping cost (via eRanger) – R2,750
Labour costs to unbox and assemble – R1,175
Overhead recover at 15% – R2,913.75
Profit at 15% – R3,350.81
Total selling price of the motorcycle – R25,689.56

Fabkomp costs for each sidecar clinic unit
Motorbike from eRanger – R25,689.56
Helmets, spares, compressor, lights, rider jackets etc. (imported via eRanger, including 25% markup) – R5,381.25
Cost of manufactured sidecar kit and mounting brackets – R3,159.50
Front suspension fork set, complete – R1,718
Cast sidecar wheel, complete – R2,650 (casting in aluminium foundry)
Gazebo plus side panels, 2 chairs and decals etc. – R6,990
Infant scale & cradle – R1,201
Adult mechanical scale – R784
Metal kidney and utility bowls, sharps container, etc. – R255
Transport – R451.83
Vacuum-formed ABS components, storage compartment, footwell, basin and toolbox – R9,600
Labour – R5,125
Initial training for licenced riders per unit (3 to 5 days) – R1,000
Management support for 4 years at R21/month – R1,015
Overhead recovery at 15% – R9,752.75
Profit at 10% – R7,477.11
Total selling price for complete clinic sidecar package – R82,250
Total selling price for complete ambulance sidecar package – R68,811

 

The Eastern Cape Health Department has put a hold on their order for 100 motorcycles with mobile sidecar clinics intended for use in the province’s rural areas, says Daily Maverick. Eastern Cape Health communications director Siyanda Manana said that, given the “public discomfort”, they have delayed issuing an order for the motorcycles but still have a contract with the company, Fabkomp, that will be manufacturing the vehicles.

“The bid adjudication committee is taking another look at the processes so that in the event that we are challenged we can be assured of a process that can withstand legal scrutiny,” he said. “We are engaging with the stakeholders and specifically with the health portfolio committee to ensure we find common ground.”

The report says the chair of the Eastern Cape Legislature’s Health Committee, Xolile Dimaza, said they had been alarmed to suddenly see the procurement of the motorcycles for use by health workers. “We must receive an annual report and an annual performance plan. The department must tell us how they will use the money that they have been given. The motorcycles were not in any of their reports. It wasn’t in the performance plan. We were not given anything to approve,” he said. “Then suddenly the scooters appeared on page 15 and 16 of the MEC for health’s policy speech.”

“We said to them, if it is not in the annual performance plan it is as good as if it has never been written.”

He said their second point of concern was that the Eastern Cape government’s fleet management policy was that procurement is done by the Department of Transport. “They are the ones who are buying ambulances and then hand them over. Our question was, why have you excluded the scooters from fleet management? Up to now, the Department of Health has never answered us.”

Daily Maverick reports that in a statement issued when the project was launched, the Health Minister, Dr Zweli Mkhize, defended the procurement of the motorcycles, saying they were not meant to replace ambulances but could be used as motorcycle clinics, mobile testing units and mobile medicine delivery units and also to transport patients to the nearest clinic.

But Harmse said the department never ordered the motorcycle ambulances – it had ordered the clinics but he was told to bring the ambulances to the launch.

According to the report, Harmse said he had no problem with the tender being reviewed. “We have not received any money and we do not have an order number,” he said. “We cannot start manufacturing the units until we receive an order number. We have other countries making inquiries and there is a possibility that Nigeria will order 68 units shortly and they will pay cash upfront. Whoever places the order first will get the 85 that we have in stock.”

He added that the demo units used in a highly publicised launch in East London had been shipped to Kenya.

In his report to the portfolio committee, he said they had received a request from the Health Department on 9 June to have a “showcase ready by the Friday (12 June). “We never had any bikes ready and we informed the department that we had four ambulances ready to go to Kenya completed and our two demo units, one ambulance and one clinic. We were then asked to have these six units available on the Friday, which we then presented on the day. The problem, I believe, was that there was no clear instruction on how to manage the proceedings as I presented what was there on show, including the clinic. The test drives were in the ambulance unit, but the order (placed by the Health Department) was for the mobile clinics.”

 

Full Polity report

 

Full News24 report

 

Statement on the Politicsweb site

 

Under The Milkwood report

 

Full Daily Maverick report

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