An audit report has found that the office wastes much-needed money and resources, and has little contact with its own hospitals and clinics
Paul Kirk
Following a series of exposes by the Mail & Guardian, auditors have recommended that the national office of the South African National Tuberculosis Association (Santa) be closed down.
The audit report, which has not yet been made public, claims that the national office of Santa in Gauteng has little or no communication with the 22 hospitals and clinics run by the association and wastes much-needed money and resources that should be used to combat tuberculosis (TB).
Dr Andrew Ratsela, the CEO of Santa, is paid a salary of R500 000 a year for working two days’ each month.
He also had a Santa credit card with a R50 000 a year limit for “incidentals”, a petrol card and a top-of-the-line BMW for his use. Previous Santa CEOs had been either unpaid volunteers or were paid a token allowance.
Following articles in the M&G about Ratsela’s package, the national Department of Health ordered an audit of the organisation, which leads the battle against TB in South Africa.
Though the audit has not yet been made public or given to Santa’s executive committee, the M&G has been shown parts of the report.
Among its findings are that Ratsela blew R5 000 on alcohol in a week, bought himself thousands of rands worth of clothing and frequently treated his entire family to lavish meals at top hotels and restaurants in Sandton.
Ratsela obtained a duplicate petrol card, which auditors suspect was used by his relatives. This financed thousands of rands worth of petrol. Ratsela denied having two petrol cards when quizzed by members of the organisation.
Santa centres throughout South Africa donate roughly 10% of their income to their national head office. Money collected by Santa centres comes entirely from donations and fund-raising schemes. It is supposed to be used by the national office to fund the administration of the association to help bail out poorer operations in rural areas.
Ratsela, according to the report, used all this income to finance the national office.
This week Ratsela agreed to be interviewed by the M&G, but changed his mind when he was told he would be questioned on the contents of the audit report. When the M&G phoned Santa’s national office, an assurance was given that Ratsela wanted to speak in order to “clear his name”.
However, when the M&G called back after the deadline given to Ratsela had passed we were informed he had left to test-drive a new 4×4.
In South Africa 160 000 new cases of TB are diagnosed every year, said Minister of Health Manto Tshabalala-Msimang at a briefing to announce the global launch of World Tuberculosis Day, which will be marked on Saturday March 24.
Tshabalala-Msimang said a new approach to combating TB establishing demonstration centres where volunteers ensured people with TB completed their course of medication had “encouraging results”. These centres will be established in every district of South Africa by the end of the year.
South Africa has one of the highest TB infection rates in the world 492 per 100 000 people.
But some Santa executive members believe the only way to break the back of TB in South Africa is to keep patients in hospital for the full course of their treatment.
Although the Dots (directly observed therapy short course) programme has worked well in nearly every country in the world, from rural Uganda to urban New York City, in parts of South Africa the scheme is failing.
Before the implementation of Dots Santa kept patients in hospital for six months, allowing them to complete their medication under supervision, and to teach them life skills needed to prevent their becoming sick again.
With Dots, patients are kept in hospital for two months, then sent back home. The idea is that they are hospitalised only for the period they are most sick.
“There are problems with sending people home to complete their course of medication. And these problems are worse in the rural areas. If patients have to travel 60km on foot to a clinic to obtain medication, then chances are they simply will not complete the course,” says John Budge, executive committee member of Santa.
“The other problem is that the medication to treat TB is quite unpleasant if taken on an empty stomach. A large proportion of the rural poor who suffer from TB are too poor to buy food and too ill to work the soil to produce food. That prevents people completing their course of medication.”
Santa staffers estimate that about half of their patients do not complete their course of medication.
“That leads to multiple drug-resistant TB,” says Budge. “If patients keeps
interrupting their treatment they are very likely to find themselves with this. And not only does it usually kill patients, it costs a fortune to try to save them.”
Additional reporting by Barry Streek