DA gets clinic stats slightly wrong

South Africa’s official opposition party, the Democratic Alliance (DA), launched its election manifesto in Johannesburg on February 23. The country’s national and provincial elections will be held on May 8.

Taglined “one South Africa for all”, the manifesto contains a number of claims about the state of the country.

This report fact-checks three claims about health facilities and land reform projects. (Note: Africa Check is verifying another two claims from the party’s manifesto. They will be added to this report once they are complete.)

The ratio in this claim does not reflect the current situation because it is based on numbers that date from the year of the previous general election.

DA spokesperson Solly Malatsi told us that the statistic was contained in the 2017 South African Survey by the South African Institute of Race Relations (SAIRR).

According to the health chapter of this report, South Africa had 3,182 public clinics in 2014.

The SAIRR, in turn, sourced this number from the work of the Health Systems Trust, a nonprofit organisation that specialises in health research.

The most recent edition of the SA Health Review from the Health Systems Trust puts the number of public clinics in March last year at 3,187 – only five more than in 2014. But because of the increase in the population size since 2014, the ratio in the claim is out of date.

Based on Stats SA’s mid-year population estimates, South Africa had 57.73 million residents last year. This would mean that there was one clinic for every 18,114 people at the time.

What is a clinic?

Candy Day, technical specialist at the Health Systems Trust, told Africa Check/City Press that the number of clinics cited in the SA Health Review applied to government-operated clinics (not private clinics) and excluded mobile and satellite clinics.

She said the source of the count was the District Health Information System, which is used by the national and provincial departments of health, and contains a categorisation of health facilities.

“In general, we do our best to provide the summary statistics, but, as with all data, there are many nuances and areas where errors or interpretation can arise,” she said.

Population not the only consideration

The spokesperson for the department of health, Popo Maja, told us there were currently 5,211 primary healthcare delivery points, of which 3,190 were clinics.

He said population wasn’t the only determinant of where and how many healthcare facilities government provides. In some cases, the ratio of facilities to people would be “irrelevant”.

Maja gave the example of the sparsely populated Northern Cape, where a small community of about 1,000 people would need access to a primary healthcare facility.

Conversely, he said, it was “not feasible” to have a facility every 2km² in densely populated areas like Soweto in Gauteng.

“In these cases, you would have primary healthcare service delivery facilities that would have up to 30 consulting rooms to enable the provision of services to the catchment population.”

‘The WHO guideline’

The DA also claims that the country’s clinic-to-person ratio falls short of a World Health Organisation (WHO) guideline of 1:10,000.

However, the document the party provided in support of this only states that the number and distribution of health facilities per 10,000 people is a core indicator for monitoring service delivery.

We were unable to find a WHO representative who was aware of the existence of the purported guideline for clinics cited by the DA in its manifesto.

Verdict: Incorrect

While the number of public clinics used to calculate the ratio closely matches the current figure provided by the department of health, the DA relied on an outdated population size. The most recent data show that there was one clinic for every 18,114 people last year.

In this case, the DA relied on a statement made by African National Congress veteran Mathews Phosa, according to DA spokesperson Solly Malatsi.

In 2017, Phosa reportedly said that “up to 90% of land reform projects are unsuccessful”.

We asked Phosa, through his office manager, what he had based his statement on, but received no response by the time of publication.

Phosa was, however, not the first to make a claim about a land reform failure rate of about 90%.

In 2010, then minister of rural development and land reform Gugile Nkwinti said at a briefing: “We have not talked about the revenue which the state has lost because 5.9 million hectares of farms that were active and acquiring revenue for the state were handed over to people, and more than 90% of those are not functional – they are not productive and therefore the state loses revenue.”

However, Professor Ben Cousins of the Institute for Poverty, Land and Agrarian Studies (Plaas) at the University of the Western Cape told Africa Check/City Press that, at the time, Nkwinti’s claim was not backed by research, and the same is true for the DA’s current claim.

Asked how the party defined success, Malatsi said it applied to land redistribution projects where “beneficiaries have managed to create economically viable businesses once land has been redistributed”.

He added that, “upon reflection”, it appeared that the actual failure rate, based on Phosa’s claim, was 90% instead of 92%, but the party believed the “overall narrative remains correct”.

The DA conceded however that, outside of the completion rate for land restitution claims, “there has been no attempt by the national government to conduct a proper audit into the success or failure of land reform projects”.

What is successful land reform?

“Defining success and failure depends on the measure you use to assess impact,” stated a 2013 Plaas fact-check on the extent to which land reform projects had improved beneficiaries’ income and livelihoods.

Cousins said, “around 50% of the projects have improved the livelihoods of beneficiaries to a degree”.

This number, he told us, was a “rough estimate” in the absence of more reliable data. It is based on research published between 2005 and 2013, including:

• A review of 43 land reform projects in North West, published in 2005, found that production was stable or had increased in 56% of cases.
• In a 2008 national survey of Land Redistribution for Agricultural Development projects (2001 to 2006), 49% were identified as stable or showing improvement, according to the above-mentioned Plaas fact check.
• A project census of 117 redistribution and restitution projects in the Vhembe and Capricorn districts of Limpopo showed evidence of activity (some production, leasing or joint ventures) in 44% of cases. The research was done from 2007 and the results were published in 2013.

We asked the department of rural development and land reform for its research on the success of land reform projects but did not receive a response by the deadline. In a parliamentary reply to a DA question, dated October 2018, the current minister said the department was not aware of the failure rate of 92%.

Verdict: Unproven

The DA’s claim is based on an untested statement made by Mathews Phosa. The party stated the failure rate as a fact despite knowing that there was no “proper” national audit on the success of land reform projects in South Africa. Currently, there is no research that supports or disproves the claim.

The audit, which covered the four years from April 1 2009 to March 31 2013, set out to determine whether a sample of land reform projects in the province was successful.

DA spokesperson Solly Malatsi told us the latest audit report, covering 2014 to this year, was not available when the manifesto was compiled.

The 135 projects that were rated as successful or unsuccessful represented just more than half of the 246 provincial projects assisted through two farmer-support programmes.

These programmes – the Comprehensive Agricultural Support Programme and Ilima/Letsema – are funded by the national government and implemented by provinces.

Eighty-four of the projects were deemed successful as they scored between 53% and 100% based on 39 criteria. These included the ability to feed the household, whether the project was viable or profitable and whether the farm was used to its full potential.

“Successful” projects made up 62% of the sample of 135 and not of all supported projects.

What proportion the 135 rated projects make up of all land reform farms in the province is not known.

How many land reform farms?

As the DA’s claim relates to farms and not projects, we asked the Western Cape government if the two were synonymous.

Bianca Capazorio, spokesperson for the province’s head of economic opportunities (which includes agriculture), said: “Technically, they are not the same thing. A land reform project is a project that is on a land reform farm.”

“However, there are instances in the province where there is more than one farmer on a land reform farm, and they are deemed to be two separate entities.”

Capazorio could not say whether the 246 projects from which the sample was selected represented all land reform farms in the province at the time.

“We simply don’t know and we believe that the department of rural development and land reform doesn’t have sufficient data on the numbers either. The 246 on our list are either farms that we have been alerted to by the department, or are farms we have supported or that have approached us for support.”

She could also not say how many land reform farms had been redistributed in the province since 1994, saying that land reform was the mandate of the department of rural development and land reform, which “is also the record keeper”.

The summary report on the audit, by urban and rural development planning company Kayamandi Development Services, identifies commodity support as a contributing factor to the success of land reform in the province. However, no mention is made of equity share schemes, which was a key success factor mentioned in the DA’s claim.

‘Not comparable’

A comparison of the provincial delivery of land reform and agricultural support services by Plaas points out that the definition of success in the Western Cape audit is not linked to a national standard or policy, and that there “are no similar studies nationally with which to compare the findings”.

Yet the DA goes on to draw a direct comparison in its manifesto between the 62% of selected projects that were found to be successful in the provincial audit and an untested claim reportedly made by African National Congress veteran Mathews Phosa in 2017, according to which “up to 90%” of land reform projects were unsuccessful.

Based on Phosa’s statement, the DA claimed that “the national government’s failure rate of land reform projects is currently standing at 92%”.

We asked the department of rural development and land reform for comment on the DA’s claim, but it did not respond by the time of publication.

Verdict: Misleading

The DA claims that 62% of “all” land reform farms in the Western Cape are successful. However, the audit on which the claim is based did not review all land reform farms in the province. In fact, the provincial government does not know how many land reform farms there are. The 62% only applies to 135 projects and to a period of four years. Furthermore, the definition of success applied in the manifesto is not standardised.

This report was written by Africa Check, a non-partisan fact-checking organisation. View the original piece on their website.

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