Formula for disaster: North West's wasted millions in baby milk
The North West health department bought R7-million worth of baby milk formula, failed to distribute it for three years, and then spent almost R2-million to incinerate the expired milk, an incident that shocked the office of Health Minister Aaron Motsoaledi.
Provincial MEC Magome Masike blames his public servants, but he and his officials cannot explain why the milk did not reach the children of mostly HIV-positive mothers on time.
This is not the first time that expensive health products have had to be destroyed after reaching their expiry date: Motsoaledi revealed in 2012 that six provinces destroyed a total of R10.7-million worth of expired medicine between April 2011 and April 2012.
The minister announced in August 2011 that the government would no longer provide free milk formula to HIV-positive mothers, in line with the World Health Organisation's (the WHO's) recommendation that infants be exclusively breastfed in the first six months.
But the highly nutritious milk formula was not outlawed and could still be provided to any child.
Yogan Pillay, the deputy director general in the national health department, said that this was "the first I'm hearing about this [formula dumping]".
Pillay was responding to questions about whether the national department's breastfeeding-first policy for HIV-positive mothers meant that stockpiles of baby formula ought to be destroyed.
The North West procured 20 000 cases of milk formula worth R7-million – using almost half of its HIV budget – in May 2011, only to destroy the bulk of it almost three years later, in January this year.
The milk expired between August and December 2013 without reaching its intended beneficiaries.
Pillay said that the policy to prioritise breastfeeding was phased in "to ensure that the stock that provinces had was used. Because you can't just buy stock one day and the next decide you are not going to use it. That's just wasteful."
The breastfeeding policy was implemented from April 1 2012, giving the North West department a full year to distribute it to mothers from the time it received the milk to when it expired.
Pillay said the national health department had worked with provincial health departments to scale down the procurement and use of formula milk "until such time that the supplies were exhausted".
"They [the provinces] always have to keep a small supply at hand," he said.
"When the mom can't express milk or for some medical reason can't breastfeed, then we would provide formula feed, but that would be done on prescription by a doctor."
The North West health department is accused by senior provincial departmental sources of procuring this large quantity of milk formula to push expenditure just before the end of its financial year, a phenomenon called fiscal dumping. This was confirmed by Masike.
"It's fiscal dumping," Masike said. "Public servants have a tendency to do this to hide non-spending."
At the time of the procurement, the province was aware that milk formula was about to be phased out as a priority baby feeding option for HIV-positive mothers.
How and why
Masike had taken part in Motsoaledi's discussion on this policy together with provincial counterparts and his senior managers. But he claimed not to know how and why the milk formula was procured at the time that the national government was on the verge of publicising its breastfeeding first policy.
He confirmed that he would not have participated in a decision to procure the milk formula.
"I need to investigate [this]. I am hopelessly ignorant when it comes to these things [procurement]."
A senior official in the North West health department, however, claims that Masike and all other political leaders, such as the head of department, knew about the arrangement.
"They wanted to look good in terms of expenditure, and went against the national directive," said the official. "In December, when everyone was on leave, the health department assembled all this milk from districts. Collections of expired milk were made from as far as Moretele and Naledi local municipalities."
Safe disposal certificates issued by Seane Medical Waste showed that the company destroyed 136 100kg of this milk using high-temperature incineration at Enviroserve's Roodepoort incinerator facility.
It took four trucks and two days to transport the expired milk from a storage facility in Mahikeng to Johannesburg, where it was destroyed.
The owner of Seane Medical Waste, Brian Seane, refused to answer questions related to the incineration of the milk.
"I can confirm that I am contracted to the North West health department, but I cannot discuss the services I render to it," he said. "You better speak to the department."
The department struggled to explain the failure to distribute the powder for close to three years, insisting instead that it was required "by law" to destroy any expired medication and other health consumables within prescribed regulation and procedure.
'Feeding people toxic milk'
Provincial health department spokesperson Tebogo Lekgethwane said that the department became aware of the undistributed baby milk formula in November last year.
"We have been engaging programme managers to find out why this milk was not distributed accordingly. The milk was distributed, but at a low pace," he said. "We feel that they were distributing without showing any commitment. It raised eyebrows why suddenly the pace of delivery was increased."
MEC Masike said that, despite losing millions of rand in buying the milk and then destroying it, the loss was better than "feeding people toxic milk".
When challenged about the fact that the milk had expired because his department had failed to distribute it to intended beneficiaries, Masike threatened to "charge people" in his department.
"Somebody is not doing their job. I pay people every month and I expect everyone to work," he said. "We are guilty of keeping this milk, but maybe people were caught napping and when they woke up, it was too late. But we are not guilty of destroying the milk that had expired."
When procuring the milk in May 2011, the North West health department's motivation was that it needed it to supply mothers enrolled on the province's prevention of mother to child transmission programme (PMTCT). Between October 2011 and March 2012 7 600 HIV-positive mothers gave birth in the province.
"As part of ensuring compliance with the infant feeding options chosen by the mothers who enrolled in the PMTCT program, the department of health is providing milk formula for the first six months of life," read a motivation seen by the M&G.
Interestingly, North West is way ahead of other provinces in the establishment of four breast milk banks at four hospitals.
This did not stop the province from spending almost half of the R16-million for its HIV and Aids conditional grant on the milk formula that was discouraged as a first option.
According to the WHO, breast milk contains all the nutrients a baby needs and protects against childhood diseases such as diarrhoea and pneumonia, which are the two main causes of deaths in children under five years in South Africa.
Previously, the government provided free milk formula to HIV-positive women to protect their babies from contracting the virus from the mother's breast milk. Research has shown that, if the mother is receiving HIV treatment and her baby prevention treatment, the risk of HIV transmission is lower than 2%.
But there is no consensus on how the policy is to be implemented, and it varies among provinces.
The Eastern Cape has been weaning moms off the government-issued formula milk for five years, and KwaZulu-Natal started implementing this policy in 2010.
Although the Western Cape is yet to fully implement the policy, it offers mothers the choice of feeding their babies only breast milk for the first six months or only formula.
Medicines, textbooks wasted
This is not the first time a province has failed to distribute procured goods and ended up either dumping or destroying them:
- In 2012, Limpopo disposed of expired medicines worth about R14-million. These included antibiotics, antiretrovirals and HIV test kits. At the time the province's 46 hospitals and more than 360 clinics had run out of medication.
- Expired medication worth about R30-million was discovered in an unauthorised medical depot in Mthatha in the Eastern Cape in November 2013.
- The Eastern Cape destroyed 19 tonnes of medicine in 2011 after an internal audit found that expired medication had piled up in hospitals, clinics and depots.
- After failing to distribute textbooks in Limpopo, some of the books were found dumped in rivers, in the veld and under a bridge. – Mmanaledi Mataboge