Accessing the Disability Grant for Chronically Ill Persons

1
Accessing the Disability Grant for Chronically
Ill Persons

• Presentation to HIVAN/MRC Forum
• 28th October 2008
• Dr Fatima Docrat

2
Setting the context

• I work at an ARV site in Durban running a clinic
  for pregnant HIV women.
• Having worked in the private sector for many
  years I had limited knowledge of the disability
  grant system
• Patients started asking me to complete forms
  given by the District Surgeons.
• The Nursing sister advised me that anyone who had
  a CD count below 200 was entitled to a grant.
• But that this clinic hardly filled any forms
  because the clinic was too busy.
• Staff at my clinic thought I would consider this
  as an imposition and did not encourage it.

3
Walking through the DG application process

• Applicant must have a CD count below 200
• Patient makes DG application at Welfare Office
  (DoSD).
• Dr sends the patient with a Blood result showing
  a CD count.
• DoSD supplies Patient with relevant forms and
  refers them to the District Surgeon (DS).
• The DS - stamps the form refers patient back to
  Clinic/Site
• Clinic Dr completes the prescribed clinical
  assessment form.
• Patient takes this form back to DS.
• DS is then is supposed to make an assessment and
  recommend to DoSD whether to accept or reject the
  application.
• DoSD informs patient of the status of their
  application
• NOW Remember this is NOT a Courier Service but a
  pregnant woman, mostly unemployed, almost always
  anaemic and sometimes sick (TB or other
  infections) making these many trips.

4
Case Study

• I would like to share with you what the reality
  is for many of my patients applying for a
  Disability Grant
• Thembi is 28 year old unemployed woman in her
  second pregnancy. I saw when she was at 28 weeks.
  She was HIV also had TB for which she was
  being treated at another clinic.
• She was thin, emaciated and tired looking, mobile
  but accompanied by her mother.
• Her CD 4 Count at that stage was 13.
• I initiated ARV treatment after assessment.
• I advised her to apply for DG because it was
  clear that if she was to go on ARV she would need
  good nutrition and she clearly wasnt getting
  sufficient nutrients presently.

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Case Study cont.

• I saw her within a forthnight to review
  treatment.
• She had been to been to Welfare and had been
  referred to the DS
• She brought forms for me to complete forms
• I duly completed these and she took them back to
  the DS
• 3 months later at a review she brought the
  original completed form back to me. (3 pages)
• It had the DS stamp on it and a request for me to
  provide a further medical report in the form of
  the letter?
• I complied with a further detailed letter (even
  though it appeared unnecessary).
• She came back a month later to the clinic, having
  been admitted to hospital in the interim period
  for dehydration and pneumonia.
• She reported that DS required a further letter
  pertaining to her TB.

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Case Study cont.

• This was now 4 months since my initial referral
• I responded in writing querying what further was
  needed as all this information had been provided.
  (3rd correspondence)
• I last saw her in September 2008 and she still
  didnt and still awaiting her grant application
• She is unable to breastfeed as she is weak and
  emaciated.
• She is tolerating the ARV treatment although the
  TB is impacting on her health.
• Not sure how she is going to care for the baby
  due to her precarious health situation.
• In comparision another patient in similar medical
  circumstance and with financial support of a
  partner is doing fairly well.
• ACCESS to DG will make a considerable impact on
  her life. What more do we want to give a mother
  of 2 children then the health to care and nurture
  them!

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Fact and Fiction?

• The clinic sees approx 60 patients a week. Since
  I have worked at the clinic (8 months) not a
  single patient has reported getting their grant
  with ease and very few actually have received the
  grant.
• NO PAY NO FORM I was told by many patients
  that to GET the DG application form you at DoSD
  you pay.
• It is alleged that DS Office requires some sort
  of payment to process application and to get
  grant.
• Figure mentioned R 300
• It is alleged that the a patients weight is used
  as the criteria for assessing eligibility for
  grant.
• Almost all patients have reported making no less
  then 5 to 6 trips to process a grant application
  its expensive and physically exhausting.
• That unless you get to the DoSD queue at an
  unearthly hour you will not be attended to that
  day.
• Patients have queried why I was encouraging them
  to apply!! There was suspicion of ulterior
  motives on my part financial gain?

8
Lessons and Recommendations

• Training and awareness for health workers of the
  Criteria for accessing Grants is essential.
• Need to Streamline systems to avoid burdening
  already stressed Health workers in processing
  applications
• Need to ensure that Health workers respect and
  support socio-economic rights of vulnerable
  people.
• Need to find ways to deal with corruption
  through public awareness Patients must know
  their rights.
• NEED new criteria for accessing DG waiting till
  people get sick does not make Financial SENSE.