As the Human Rights Commission (SAHRC) began three days of public hearings on health services, based on a nine-province review, one of its most shocking findings is that poor patients are effectively being excluded from healthcare if they can’t afford to pay for transport.
In preparation for the public hearings, which began in Johannesburg on Wednesday, the SAHRC visited 91 health institutions countrywide. The picture that emerged is one of a “leadership vacuum” in which “things happen but nobody cares or hears”, according to the commission, which has mooted an independent ombudsman to monitor patients’ access to healthcare.
In Mpumalanga poor roads and long distances pushed up the price of fares to hospitals to about R90, while in the vast Northern Cape patients had to pay up to R500 to get to a hospital. In KwaZulu-Natal patients needing more specialised tertiary level care could pay as much as R400 for transport, while in the Eastern Cape the lack of public transport, as well as cost, hinders access.
At the same time, ambulance services are “at best inadequate and at worst non-existent”. While the Constitution states that “no one may be refused emergency medical treatment”, the review questions whether this has any meaning when there are no ambulances to transport patients.
“In some cases, ambulances arrived after five or six hours or even the following day, when the patient had already died,” notes the review.
Massive staff shortages, especially of nurses, also featured prominently. “The shortage of staff in the health system is creating a vicious cycle leading to extremely stressful working conditions as well as unduly high workloads for those remaining, resulting in further staff leaving,” notes the report.
A new hospital in Calvinia, with modern equipment, “had not been able to perform any operation, not even the removal of tonsils, due to unavailability of qualified nurses to assist at theatre”, observes the review.
Poor pay and working conditions were causing staff to leave, according to those who spoke to SAHRC staff.
“There is a strong sense that more needs to be done by the department of health to attract nurses to fill vacancies, and to retain them by offering better remuneration packages, incentives and career advancement opportunities, as well as improved working conditions.”
Patients also complained about the callous attitude of health workers. “Night staff seems to be especially likely to treat patients callously,” notes the review.
The overall impression is that the health system is under-funded and battling to meet demand, particularly as the HIV/Aids epidemic has “quickly absorbed” funding increases, notes the report.
The report concludes by recommending that constitutionally “the right to health” needs to be defined in practice and linked to what health services need to be in place “to qualify as providing access”.
SAHRC chairperson Jody Kollapen said the first day of the hearings was “intense”, with submissions by Karl von Holdt on behalf of labour think-tank Naledi, and Dr Kgosi Letlape of the SA Medical Association.
The submissions picked up on several recurrent themes noted in the review, most notably the yawning divide between the private and public health care systems, the degree to which bureaucracy bogs down attempts at change, and the high vacancy rate.
Kollapen says the difficulties that the poor and vulnerable groups — such as refugees and homosexuals — encounter in attempting to access health services means that some people do not get any healthcare services: “They simply fall out of the system”.
Health Minister Manto Tshabalala-Msimang will make her submission on Friday June 1. — Health-e