As the health system risks buckling under the pressure of budget constraints, Eastern Cape doctors are now refusing to work additional overtime without compensation.
They told Health-e News that they already work the prescribed 80 hours, and “unfortunately, we could not go beyond that”.
At Oliver and Adelaide Tambo Hospital in Mbizana last week, they refused to stay on-call overnight, leaving nurses to take care of patients and those needing urgent care being referred to other hospitals.
On Tuesday, a document which appeared to be written on the provincial department’s letterhead and was apparently signed by hospital CEO Mziyanda Tshaka – and addressed to patients – was circulated on social media.
It read:
“…There will be days where there will be no doctors on call starting from 20 January until further notice, due to an acute shortage of doctors. However, all patients will be given vital signs and nursing services and patients in need of medical consultation by doctors will be transferred to a nearby hospital.”
On Wednesday, the provincial Health Department released a denial, calling the notice “fake news”, saying 16 doctors worked every day at the 100-bed hospital servicing a population of more than 280 000 people.
But their statement was disputed by X user @ PhakathiSba, who shared what he said was the hospital’s call roster for January.
Phakathi, who works at the hospital, said the roster shows no doctors on call from Monday to Thursday this week. Additionally, from Monday next week until Friday, there will be no doctors on call.
“This is not fake news. I work in this hospital. There’s no doctor on call in casualty as we speak. The spokesperson is lying then.”
— Dr Sba Phakathi (@PhakathiSba) January 21, 2025
Another doctor told Health-e News that having only 16 doctors was simply not enough, and no one was willing to work extra overtime without compensation.
Overtime a long-standing issue
Doctors’ overtime has been a contentious issue for years, with several provinces introducing changes that have angered medical staff.
For instance, in May 2023 the Limpopo Department of Health proposed adjustments to the working shift system to slash doctors’ overtime hours, while in the 2024/25 financial year, Gauteng Health withdrew the power of hospital CEOs to approve commuted overtime.
Last week, doctors in Mpumalanga threatened to limit their working hours to 8am until 4pm, refusing to work beyond those hours without proper compensation.
During the delivery of the Medium-Term Budget Policy Statement in November last year, Finance Minister Enoch Godongwana said there would be no adjustments to the Health budget.
Burden falls on nurses
When doctors are not available nurses often pick up the slack, said Democratic Nursing Organisation of South Africa (Denosa) Eastern Cape secretary Veli Sinqana, who confirmed there were no doctors on call at the hospital on Monday night and that nurses have now decided to stick to their core duties.
Doctors at Oliver and Adelaide Tambo Regional Hospital “were unavailable for overtime”, which poses a risk to patients, as nurses had to communicate with the clinical manager or contact doctors from other hospitals for consultation, “which ….delays crucial care”, he said.
South African Medical Association Trade Union (SAMATU) Eastern Cape secretary Dr Zukiswa Gonya said the shortage of doctors was a common issue across the province.
“They have tried to overstretch and work beyond the 80 hours, but it is too much. And they are not getting paid for the extra work. The provincial Health Departments are now threatening to remove the commuted overtime (duties performed in addition to the normal working 40 hours) which means doctors will work from 8am to 4pm every day.”
Gonya said this would have an impact on the patients.
“As it is, the Department of Health faces billions of rands in medico litigation. How will hospitals avoid these claims when patients have to be transferred to other facilities? In rural Eastern Cape it can take about an hour to reach another hospital if you are lucky enough to get an ambulance.”
Nurses up in arms
At Dora Nginza Hospital in Gqeberha, meanwhile, fed up nurses also made their voices heard in a pay dispute, initiating in an illegal three-day strike that placed patients' lives at risk and created chaos at one of the biggest hospital in the province.
Eastern Cape Health has promised “severe consequences” for all strikers.
News24 reports that nurses who downed tools last Monday and demanded their overtime pay were joined by maintenance, general and clerical staff.
The protesters burnt tyres and blocked entry to the facility by barricading roads and locking the gates.
They refused to let ambulances in or out, and according to one nurse, anyone who did not want to take part was physically removed from the wards and forced to protest.
“I did not want to have anything to do with this strike. I wanted to keep my head down and do my job, but they targeted us … grabbed every nurse they could and forced us to down tools.”
“I didn’t agree with their hostility … It does not matter what you are striking for; if you don't do it legally and with some order, there is no point,” she added.
The protesters also closed the kitchen, so patients went hungry.
Department spokesperson Siyanda Manana described the strike as “inhumane”, saying although it fizzled out on Thursday morning, it did not mean those involved would be let off the hook.
“The strike was illegal and unprocedural and violated all protocols. They put the lives of patients and staff at risk, and lives could have been lost.”
On consequences for those involved, Manana said a team from head office had been dispatched to break up the strike and was “engaging with the staff to decide on their punishment”.
However, “no option apart from disciplinary action” would have to occur.
“To lock a kitchen to deny people their food … it cannot be left like this.”
Manana added that the striking workers were each only owed eight hours of overtime, and that payment had been authorised and should be reflected in their accounts by 10 February.
He said although there were no injuries or fatalities, patients and staff were left “traumatised”.
Department blamed
After a meeting at the hospital by union representatives and striking staff, Denosa Eastern Cape chairperson Vuyo Dlanga blamed the department for not “adhering to the method for outstanding overpay as agreed last year”.
He said that union representatives had notified management about the strike, writes GroundUp.
“Our members were inside and only went out to picket. That’s when they were locked out. We have heard the employer plans to take stern action against them, but as a union we’ll be monitoring this.”
Provincial secretary of the National Union of Public Service and Allied Workers Mzikazi Nkatha said: “The main grievance was that overtime payments had not been paid since October 2024. Workers are forced to work overtime due to staff shortages. This is a major problem across the Eastern Cape.”
Nkatha blamed the department for failing to fix the province’s health system, despite numerous concerns raised by unions and civic groups. “We have been engaging them since 2024, and are now faced with angry workers.”
The strike was a reflection of the situation at all health facilities, not just hospitals in the province, he added.
Numerous patients were turned away from the hospital, one being a mother who had brought her son from Makhanda for an operation on his broken arm. She said they woke up early to catch the department’s free patient transport to Gqeberha.
“I am desperate,” she said. “My son is in terrible pain. There are no nurses to attend to anyone so we are forced to go home. They did not even give him pain killers.”
GroundUp article – Health workers bring Gqeberha hospital to a standstill (Creative Commons Licence)
See more from MedicalBrief archives:
Maternity unit strike at Dora Nginza Hospital, Eastern Cape, ends
EMS staff in illegal strike in the Eastern Cape
Nurses strike over unpaid overtime
Hospital patients, staff hit hard by public sector strike