clinics
A report describes the serious lack of basic facilities at many hundreds of health clinics, writes Andy Duffy
THE grave lack of basic facilities in clinics around the country, undermining the government’s new health policy, is revealed in a report to be published next month. Hundreds of clinics have no access to electricity and water. Hundreds, too, do not have telephones.
The clinic network is central to primary health care – a key component of the Health Department’s drive to provide universal health care. The government has spent R680- million on primary health care in the past 12 months, including R190-million on new clinics.
But the report, prepared by department consultants Health Systems Trust, shows that more than half the 645 clinics in the Eastern Cape do not have grid electricity. Nor do 126 of the 300 North West clinics and nearly a quarter of the Northern Province clinics. Adequate water supplies do not exist for nearly one-third of the clinics in the Northern and North West provinces, nearly half the Eastern Cape clinics and a fifth of the 402 clinics in KwaZulu-Natal.
In terms of government planning, clinics are to shift much of the burden away from main hospitals, providing a more cost-effective and wider spread of medical facilitiies. At present, many hospitals have to deal with minor ailments which could be treated at clinics.
Health Department Director General Olive Shisana declined to comment ahead of reading the report, but says some of the information could be incorrect. “We take note of what they produce but it does not mean everything they say coincides with the facts,” she says.
The report, South African Health Review, also questions planning and funding for health policy, particularly the redressing of imbalances in provincial budget allocations. It says health policy remains hamstrung by lack of clarity about funding.
The report notes that up to 1 000 new clinics could be needed to meet the government’s primary health care aims. But it is not clear whether staff or money for recurrent expenditure are available, nor whether the provinces needing clinics have the capacity to spend the cash.
The inability to spend could also delay the reallocation of resources between provinces. “The ability of provinces which have previously been relatively underfunded to absorb significant budget increases is limited,” the report says.
Shisana says that she will wait to see provincial health spending figures before deciding whether the report’s conclusion on spending ability is correct. She adds that decisions to build new clinics are only cleared once funding, including provision for recurrent expenditure, is agreed. Providing water, electricity and telephone links to existing clinics is a priority, although the timing hinges on performance by the relevant parastatal.
The department is providing R10 000 to each of the 2 358 established clinics for “minor upgrades” such as redecorating, she says.
The report also says that the move toward universal health care is likely to prompt an increase in the number of patients referred from clinics to higher levels of care. However, it describes many existing hospitals as “dilapidated”, with “crumbling electrical, water and steam systems … Many facilities are nearing the end of their useful lifespan.”
More than a quarter of existing hospitals need to be replaced, the report says. The cost must still be determined.