In November last year hospitals in the Eastern Cape ran out of money to buy medicines and food for patients
Scotch Tagwireyi
Sister Elizabeth Mokoni (37) of Natalspruit hospital’s paediatric department on the East Rand is haunted by the sound of crying babies. Her concentration is beginning to lapse. She can’t stand noise even the sound of her radio and television sets or the noise made by her children playing at home.
“Sometimes when I go to bed I dream about these babies,” says Mokoni. “I also have a seven-month-old baby, and each time I see these children crying I think of my baby.”
Mokoni and two other colleagues take care of more than 60 ill babies, aged between one and 12 months, in two 12-hour shifts a day. Her working conditions are not unique in what appears to be an unfolding trend in many public hospitals plagued by a variety of inadequacies, such as ageing buildings, a shortage of equipment and medicines, understaffed units and a growing population of patients.
Some of the public hospitals were built as far back as 1860. Natalspruit hospital was constructed in 1973, but most of the buildings are already in a state of disrepair. There are roof leaks, busting water and sewage pipes; the floors need new tiles and the lighting is very poor.
The hospital is built on top of a mine, which makes expansion impossible. “At some point two wards just disappeared into the ground,” says matron Martha Khumalo.
The staff complement at Natalspruit has shrunk over the past two years from 1 093 to 871. Nurses who resigned have not been replaced. This has put the remaining staff under undue pressure to cope with an average of 15000 patients a month.
The situation is further aggravated by the impact of HIV and Aids. “We now receive a high number of very ill patients and they have to stay longer in the hospital than normal,” says Khumalo.
“Most patients in the paediatric section come in and out all the time for chest treatment and diarrhoea because some are HIV-positive,” says Sister Puleng Maoke, who is responsible for the paediatric section. “Admission is around 110% and sometimes goes up to 140%.”
Natalspruit is a 784-bed hospital, but with the increasing number of patients the hospital has had to add 70 more beds without waiting for government approval.
This increase in patient numbers poses serious budgetary constraints. A hospital the size of Natalspruit needs about R106,5-million a year to function properly. However, according to Khumalo, the government allocates only 75% of that amount and as a result the hospital has not been in a position to acquire new equipment or do repairs in the past financial year.
A survey conducted by the Gauteng provincial government in 1999 on the state of five hospitals in the province identified problems related to poor management, shortage of staff and medicine, long queues and bad staff behaviour. The survey also found that on certain occasions surgical operations had to be cancelled because of a shortage of linen.
The five sampled hospitals are Chris Hani Baragwanath hospital, Natalspruit hospital, Pretoria Academic hospital, Sebokeng hospital and Tembisa hospital.
According to the national Department of Health, the worst-affected provinces are the Eastern Cape and KwaZulu-Natal. In November last year, five months before the end of the current financial year, hospitals in the Eastern Cape ran out of money to buy medicines and food for patients.
An audit commissioned by the government in 1996 to investigate the state of public hospitals nationwide reflected a bleak picture. The audit report, compiled by the Council for Scientific and Industrial Research, recommended that in order to remedy the deteriorating condition of public hospitals, the government has to rehabilitate most of its 359 public hospitals, revamping some and replacing others completely.
The report indicated that about 30% of the hospitals are in a serious crisis, and 11% of these need to be replaced, while 19% need a major revamp.
“The hospitals have been neglected over the past few years,” says Dr Thabo Sibeko, director of hospitals in the Department of Health.
Sibeko blames bad management for the poor state of hospital conditions. “There are modern methods of running hospitals and the managements in our hospitals are not up to the standard. With a bit of efficiency the situation will be very different.”
Sibeko says government policy puts more emphasis on primary health care than on infrastructure, an approach with a bias on prevention rather than cure. However, the government is working on the Council for Scientific and Industrial Research’s recommendations.
To this end, government has committed to spend about R10-billion over the next 10 years, to rehabilitate, replace and revamp public hospitals. This capital injection would also involve a World Bank loan and technical expertise necessary to the hospitals. So far the government has spent about R1,7-billion on public hospitals over the past three years.
While waiting for assistance from the World Bank, the government is currently decentralising hospitals’ management structures by appointing CEOs to run hospitals on business principles. “In the past experienced doctors used to rise through the ranks to become superintendents, but now we are looking for someone with business knowledge,” says Sibeko.
The government is also looking at establishing partnerships with private hospitals, working on the assumption that about 40% of the facilities of the country’s 345 private hospitals are underutilised. The government is considering hiring these facilities to ease pressure on public hospitals.
Also on the cards is a programme to provide home care for HIV/Aids patients to relieve pressure on existing infrastructure.