Blame game gets Gauteng nowhere
Another day, another story about state patients dying and suffering. Another distressed letter from desperate health workers. Another call for action and accountability from civil society. Another statement from the government. Another day in Gauteng.
A week has hardly passed in the past year without a media report detailing a horror in a Gauteng hospital or clinic. These have included heartbreaking reports from doctors detailing newborn babies dying or being left brain-damaged at Chris Hani Baragwanath Hospital because of nurse shortages; doctors being forced to play God because they must choose which patients to resuscitate and which ones to leave to die at Charlotte Maxeke Hospital; cancer patients unable to access treatment at the same hospital because of broken equipment; drug shortages for life-threatening paediatric illnesses at Rahima Moosa Mother and Child Hospital – the list is endless.
In an attempt to understand why Gauteng, considered the economic hub of South Africa, is unable to offer its citizens effective and accessible healthcare, Health-e spoke to a number of health workers, activists and government officials. None would be named, but there was general consensus that the crisis was the result of years of poor administration and financial mismanagement, which the provincial department and politicians oversaw.
"The premier always reacts when there is an article in the newspapers; she stamps her feet and a week later nothing has changed and everything is quiet again until the next article," said a frustrated activist.
Section27, the public-interest law centre, agreed when it said in a statement: "Each time a crisis hits the newspapers, instead of addressing the underlying issues related to overspending, the Gauteng department of health first denies that there is a problem. Then they shift spending from one area to another, effectively fighting fires rather than addressing the core issues with a structured attempt to develop a realistic needs-based budget that facilitates the delivery of healthcare services to the public."
After media reports about the situation at Charlotte Maxeke, Premier Nomvula Mokonyane reportedly swooped in like a superhero, holding a four-hour emergency meeting with her new health MEC, Hope Papo, and staff. She apparently had harsh words, accusing her staff of making her look like a fool. However, a few months ago when a number of senior doctors tried to meet with Mokonyane and her then health MEC, Ntombi Mekgwe, they were spurned. Sources at the meeting reported that Mokonyane and Mekgwe were dismissive and refused to attend a meeting the national health minister had organised to bring the groups together.
This attitude permeates down to the administration, which has displayed a similar attitude and does everything in its power to sabotage meetings between the health department and clinicians.
The province's health woes have been building up for well over five years through constant overspending, spending on unfunded mandates and the awarding of lucrative contracts to government allies who have failed to deliver.
Historically, the money allocated for health has been inadequate to meet the needs of patients living in the province and this has resulted in debt snowballing year after year.
Forensic audits indicating corruption have not been followed up. However, the Hawks are investigating R1-billion worth of tender fraud and the former head of department and chief financial officer have been charged with fraud.
Critical challenges facing Gauteng include:
- Continual shortages of essential medicines in healthcare facilities linked to the non-payment of suppliers and poor supply-chain management;
- Shortages of staff such as doctors and nurses, because the system requires the Gauteng head of department, Dr Nomonde Xundu, to sign off any new posts, a process that has reportedly caused huge delays;
- Severely curtailed laboratory services because the province fails to pay its bills and the National Health Laboratory Service has been forced to reduce staff, services and shifts;
- A breakdown of critical equipment for cancer, surgery, diagnostics and trauma linked to suppliers not being paid; and
- The collapse of the emergency medical services.
The Gauteng health department recently reported that it had settled most accruals from previous financial years, hinting that a turnaround was under way. However, what it failed to disclose is that to do this it used funds meant for service delivery this year, which has resulted in overspending on its first-quarter budget.
Overexpenditure this early in the financial year will repeat the annual cycle of improper use of funds to settle debts and accruals. The effects of this approach are at the heart of the systemic crisis facing the province's health department and are devastating for the millions of patients who are dependent on public healthcare facilities.
There are also austerity measures in place, but they will only serve to compromise service delivery.
- As each crisis pops up, the spin doctors are quick to react and give assurances that the challenges are being addressed. It is helpful to take a closer look at some of the more recent ones:
- Shortages of medicines (including antiretrovirals and oncology medication): The health department recently reported that the availability of antiretroviral medication had improved to 71% and stock levels were up to three months. It said communication had been sent to healthcare facilities to start issuing between one- and three-month supplies to patients because supply had improved. But activists point out that the 71% referred to was stock levels at depots and not at healthcare facilities. The majority of patients in Gauteng are therefore not experiencing an improvement in the availability of essential medicines. No explanation has been given for the disruption in oncology services.
- Shortages of staff: The department reported that there was a moratorium on appointments to manage a shortage of funds in the budget, but it gave assurances that critical posts were now filled. This has not been the experience of hospital staff, who continue to experience a shortage of personnel in critical positions and report massive bureaucratic hurdles when they attempt to fill these posts. Candidates often leave before permission is finally granted.
- Improved turnaround time for laboratory service results: The National Health Laboratory Service has restructured since the crisis in the past financial year. But health workers say services remain dysfunctional and the turnaround times for results are still long.
- Emergency medical services: The health department has acknow-ledged that this service is in crisis, partly owing to a failure to find someone to run it.
"The chickens are finally coming home to roost," said a treasury source, who asked to remain anonymous. "This is the legacy of years of poor management and corruption, which has created huge distrust between the provincial treasury and the health department."
As with all such matters, there are a lot of fingers being pointed and blame being shifted, but ultimately there needs to be accountability.
The question has to be posed: Where have the Gauteng legislature and, in particular, the provincial portfolio committee on health, which Molebatsi Bopape chairs, been in all of this? Their silence is conspicuous and has been for a long time. When concerned parties have raised issues with it, the committee has said that it would follow up, but then nothing happened. It has a constitutional obligation to hold the executive and the administration to account for poor performance, but has failed to do so.
Also of concern is that, in several public statements, both the executive and the administration have sought to shift the blame for many of the issues to doctors. This is disingenuous because there has been gross negligence on the part of the executive and the administration for a long time. Civil society has warned of the impending budget crisis and doctors have repeatedly raised their concerns around funding, but no proactive or meaningful action has been taken. Instead there have been denials and then claims that the situation with the budget shortfalls had been resolved.
The ANC's elective conference takes place in December in Mangaung. The Gauteng premier has the support of the ANC executive and is a valuable Jacob Zuma ally in a province where support for the president is waning. This explains the Cabinet's reluctance to order a section 100 intervention, which allows the national government to intervene in provincial matters, as has happened in Limpopo.
Gauteng has already made noises against the national department and the treasury's attempts to intervene.
It appears that politics is preventing meaningful dialogue and collaboration between the national departments and the province to solve the problems. Simply put, for the foreseeable future, politics will remain the winner and patients the losers.
This article was first published on health-e.org.za