Public Service Commission in the Eastern Cape Release Findings and Recommendations Following Inspections Conducted at Cecilia Makiwane (Mental Hospital Health Unit) and Frere Hospital (Nurses Home in East London

03 December 2019

Following unannounced inspections at the Cecilia Makiwane Hospitals Mental Health Unit and Frere Hospitals Nerina House Nurses Home in August 2019, the Public Service Commission (PSC) has completed its report which contains key findings and recommendations. .

Prior to the PSC inspection of the two health institutions, there were media reports that alleged that the Cecilia Makiwane Hospitals Mental Health Unit in particular, was in disrepair, with broken windows, abandoned medical equipment, and exposed electrical wiring which poses a danger to the patients and staff. The media reports also suggest that the Hospital does not have a psychiatrist since December 2018 and security is virtually non-existent, which leaves both staff and patients at risk. Furthermore, the media report mentioned that there was a dire shortage of staff and that patients did not have recreational facilities. Similarly, the patients and staff were also traumatized.

After the PSCs unannounced inspections at the above mentioned health facilities, the following were found:


The PSC found that:

  • The conditions of the old structure of the Mental Health Unit were indeed in a position of total disrepair as they have not been maintained for years.
  • The windows were broken, the walls peeling off and electrical wires in the passages were exposed which posed a serious threat to staff, patients and the citizens
  • Both male and female psychiatric wards have 25 beds each and were not fully occupied. However, they were neatly maintained.
  • In the psychiatric ward, at certain times of the day, in-patients were taken to the two courtyards to allow them to socialize with each other. The courtyards were secured with high wall and fence and the floor covered with concrete slabs and few mounted chairs.
  • Some patients in the male psychiatric ward were lying on the concrete/cemented floor basking in the sun, and the PSC found this to be an unacceptable way of treating patients.
  • There were no beds allocated to the restrain/seclusion rooms. Floors in the secluded areas were just cement with no carpets and mattresses. Furthermore, there were no chairs provided for patients to make them feel at home while in seclusion, thus promoting recovery. Also, there were inadequate ventilation in the seclusion area.
  • While the secluded areas were provided with the fixed cameras to monitor operation, the PSC is concerned that none of those cameras were in a working condition. As a result, the officials would not be in a position to monitor the well-being of patients while in seclusion areas.
  • Also of concern to the PSC is that the secluded areas were not environmentally friendly and were designed like apartheid secluded prison cells and such structures are not good places for healing and rehabilitation.
  • The patients records were kept in a safe and secure place, however, the documents were not properly filed.
  • Although there are designated nursing staff, Social Workers and a therapist in the Unit, the PSC is concerned that the Unit does not have a full-time Psychiatrist.
  • Some members of staff generally appeared professional, well conversant with their work, friendly and helpful.
  • There were generally concerns around the functionality of the air conditioners in the Unit. Only the lounge area had a functional air conditioning system.


In light of the above-mentioned findings, the PSC recommends the following:

  • The Cecilia Makiwane Hospital should demolish the Seclusion Wards and replace them with environmentally-friendly rooms that are provided with the necessary equipment for the utilization of patients.
  • The Cecilia Makiwane Hospital should set funds aside to fix the dysfunctional camera in the restraint or seclusion room in order for the psychiatric staff to be able to monitor the movement of patients detained in that room. Whilst waiting for the long term fixing of the seclusion rooms, matrasses/beds and other safety equipment should be installed in these rooms.
  • The existing building requires a major facelift as the conditions outside the old building reflects the high degree or standard of uncleanliness and lack of years of maintenance.
  • Lastly, the resting areas (courtyards) for both male and female patients must be provided with the necessary equipment to avoid patients resting and lying on the cement floor.

In respect of the Frere Hospital (Nerina House Nurses Home), the following were found:


  • The hostel is inhabitable and generally a physical and health hazard to both student nurses and their visitors.
  • There was heaps of uncollected waste pile alongside the entrance into the hospital. Pungent smell in the first and second floors of the hostel accompanied by buzzing flies and maggots.
  • The PSC noted that waste was last collected in January 2019 by the municipality. The state of the hostel posed a serious health threat to students and workers alike. Of concern is that students prepared their meals under these dire health conditions
  • The infrastructure of the building is dire and the building has not been maintained for a long time and requires a face-lift.
  • The window seals were broken, doors vandalized and the roof is dilapidated. In other rooms, the wooden floors were falling apart.
  • The PSC noted that there were numerous burglaries that took place in the hostel before due to lack of visible security. Laptops, cell phones, clothing and other accessories of the students were seized by criminals during those burglaries.
  • A security guard was dispatched by the hospital on the day of the inspection upon learning of the PSCs inspection.
  • The lounge areas were infested with old and unused beds and mattresses.

In light of the above- mentioned findings, the PSC recommends the following:


  • The Eastern Cape Department of Health (ECDoH) should, as a matter of urgency, consider closing down Nerina House Nurses Home, whilst alternative accommodation for students is sought by the Lilitha Nursing College (a plan of action to relocate to be effected within 30 days).
  • The ECDoH should set aside emergency funds to cater for the refurbishment of Nerina House Nurses Homes deteriorating (ageing) infrastructure. An action plan in this regard should be developed in conjunction with the Department of Public Works to renovate the building.
  • The ECDoH, should develop an aggressive approach in improving the safety of students by means of employing security guards in the premises to prevent unauthorized personnel from entering the building. Procedures on access control should be strengthened to deter criminal elements from committing further burglaries in the premises.

The PSC has submitted the Reports to the ECDoH and some of the recommendations are being implemented.  

Issued by the Public Service Commission

For enquiries, please contact: Mr Loyiso Mgengo, Provincial Director: Eastern Cape; Tel: 043 643 4704; Cell: 072 725 5348, Email: or Mr Humphrey Ramafoko; Tel: 012 352 1196; Cell: 082 782 1730; Email:

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