Pat Sidley
Gauteng’s public hospitals are in a state of crisis. Hospital budgets are strained to breaking point, as the government has cut a whopping R600-million from the province’s health budget and sent the money to historically under-served provinces.
Patients crowd Gauteng’s health services from all over the country, but there is no way yet of charging better-funded provinces for this care. Johannesburg Hospital takes in 1 500 patients a day. At Sebokeng, they have given up counting.
Heart surgery at Johannesburg Hospital may soon come to a halt — there are too few physiotherapists. The hospital’s drug funds run dry at the end of next month.
No management system functions in any of Gauteng’s hospitals. Information systems have failed. Nobody knows what anything costs.Most doctors on the lower rungs of the public health system are underpaid and work under trying conditions.
With no money in the kitty, doctors leaving the public service, and with about1 300 posts for doctors unfilled, what is to be done to ensure that the public health sector plays its role in a future health system?
The proposed plan drawn up by the committee looking into a national health system said that incentives needed to be found to keep public health doctors in the system, ensure that they work in certain areas and attract private-sector doctors into arrangements to serve the state. But talks between doctors and the government stalled on the fact that doctors in the public sector are regarded as part of the civil service — and not as professionals. So they stand in line with people who are struggling for a very basic minimum wage and their demands tend to fall on deaf ears.
Health minister Dr Nkosazana Zuma has taken the issue to Deputy President Thabo Mbeki in the hope of finding more cash for doctors, and has set up a committee comprising members of her department and doctors in the public sector — largely drawn from the Medical Association of South Africa (Masa).
The committee is looking at ways of addressing the conditions of service of public-sector doctors as well as internship and community service.
Dr Olive Shisana, Director General of the Health Department, says the issue of incentives to attract doctors is under discussion. She says the department is not looking to match private-sector salaries, but rather pay a “decent” sum. She hopes a means to address this will be found within five years.
She is mindful, however, that present interns’ salaries are too low to pay back study loans unless they turn to private practice.
A plan, which has gained currency among provincial planners, hospital administrators and Shisana, would give hospitals more autonomy and a fixed budget. This would allow them to manage their own resources. Among the problems it would raise is the delicate relationships between the various labour groups in the public service and their employers in the civil service. It also presupposes management ability, management systems, information systems and the like, all in short supply in public hospitals.
Professor Dave Morrell, who represents public-sector doctors for Masa on Zuma’s committee, says doctors in the civil service are in a weak position, which is why they would like to be seen as a separate category, out of the public-service commission. He believes that the short term will see the deficiencies “patched up” until a whole new system was in place which would address all the issues appropriately from training through to hospitals service.
One protagonist of the increased autonomy school is Dr Warwick Sive, one of Johannesburg Hospital’s superintendants, who points to the R75-million annual drug bill and says a saving of just 10 percent in this would free money for an information system, something the hospital needs badly. But the present method of budgetting sees to it that this cannot happen.There is no incentive to cut the drug bill, and if it could be cut, the savings could not be transferred into some other area which needed the resources.There is, he says, a great deal of unused space in some of the public hospitals, like his own, which could be put to income generating use — for private patients.If his hospital could have management autonomy, with proper management information systems and retain its income, many of its problems would be solved.