Health Minister Aaron Motsoaledi announced on the eve of the long weekend that Cabinet had invoked Section 100 of the Constitution to place the North West Health Department under national administration after a 10-week strike and violent protests aimed at removing Premier Supra Mahumapelo has resulted in patient deaths and a province-wide shortage of medicine.
Health-e News reports that Motsoaledi, Minister in the Presidency Dr Nkosazana Dlamini-Zuma and the Finance Minister Nhlanhla Nene are heading the task team that has to report back to Cabinet within two weeks on issues driving the crisis and plans to address these.
The report says the strike by the National Education, Health and Allied Workers Union (Nehawu), which started on 19 February, has resulted in a lack of most medicines including antiretroviral (ARV) medication for HIV positive patients. Nehawu organises the lower echelons of health sector workers, including cleaners, porters and clerks. Its members have been on a go-slow at the medicine depot, which has meant that many clinics and hospitals have not received their medicine orders.
Nehawu members have also barred doctors and nurses from entering some clinics and hospitals, depriving seriously ill patients of care. At least two people have died as a result.
Last week, Mahikeng Hospital in the province’s capital was shut down because of a lack of medical supplies. Patients were being turned away and medical staff had not reported for work, claiming they felt demoralized, knowing there was nothing they can do to assist patients.
Also, the report says, lecturers at Klerksdorp’s Exelsius Nursing College are on strike, demanding a salary increase and students are forced to do their classwork in their rooms.
Nehawu’s worker-related demands include 5% across-the-board performance bonus payments, the filling of vacant posts, salary increases for medical depot workers and the absorption of community health workers into the sector. Its political demands include an end to corruption and the dismissal of Dr Thabo Lekalakala, the head of department who is currently suspended.
The report says the the province, last week, finally fired Mediosa, the Gupta-linked private company that was paid a massive R180m in an irregular tender merely to deliver two miserable mobile clinics. In addition, the army was called in to help pack and deliver medicine.
Stop Stockouts, an NGO that monitors medicines shortages, says it has been informed that ARVs, particularly second-line ARVs which are critical, are running low in the province. The organisation’s Glenda Muzenda said the organisation had noticed a spike in the number of stockouts reported via their hotline since the industrial action. “Patients have indicated an increasing problem across the province, and many are being turned away from clinics which have run out of medication or have been given lesser quantities,” said Muzenda. “We have received over 50 reports of stockouts which is really concerning because no patient should be sent away without medicines.”
“We are urging both the National and Provincial Departments of Health to act swiftly to resolve the strike, as it is now compromising the lives of people who depend on public health services in the North West,” says Muzenda.
The report says the crisis in health intensified last week with the widespread unrest in the province as residents took to the streets to demand the resignation of Mahumapelo. The protests flared up on Wednesday in Klerksdorp, and protestors refused to allow medical staff to enter Tshepong Hospital. A patient who had been stabbed on the neck died in the hospital as protestors prevented health workers from helping him. Medical staff at a clinic in Khuma near Klerksdorp, said some patients had been sent home without their chronic medication, which put them at risk of strokes and heart attacks.
Districts in the province have reported over 90% of its medicines are out of stock and that health finance management is in a mess. Recently, a review of the hospital revitalisation programme by the parliamentary budget office found that, although the entire budget for had been spent, only 20% of targets had been reached.
The report says included in their demands was a request for an investigation into the controversial R180m contract awarded to Mediosa. However, Mahumapelo blamed the strike for ‘delays’ experienced by the forensic investigations into Mediosa. “Investigators are unable to obtain critical documents and information which is held on the premises of the Department of Health,” said Brian Setswambug, the Premier’s spokesperson.
On 5 April, Mahumapelo appointed a team of MECs to address problems in the health sector, including Nehawu’s demands, but it remains unsuccessful.
According to the report, the South African Association of Hospital and Institutional Pharmacists (SAAHIP) warned that a lack of medicine “can result in devastating consequences for patients. Not only is death a possibility in some cases, but patients who have been stabilised on chronic medicines risk having inadequate control of their ongoing medical condition, while patients needing medicines for acute conditions face the possibility of not receiving medicines at all”.
The report quotes as saying that he had discovered that the medicine shortages had been fuelled by a private company contracted by the Health Department which had failed to deliver medicines. “We discovered that the single depot that supplies all 400-plus healthcare facilities was full. It was overflowing in fact, but the medicines were not being delivered. As soon as we discovered the guys responsible we sent them packing,” he said.
The South African National Defence Force was then called in to assist with the delivery of medication, and military doctors were also dispatched to help.
Nehawu’s initial demands included the suspension of the head of the Health Department, Thabo Lekalakala, who allegedly made a pre-payment of R30m to the Gupta-linked company, Mediosa. Polity reports that they also want performance bonuses, which they say haven’t been paid for years.
Last week, Mahumapelo finally gave in to the pressure and suspended Lekalakala – based on a preliminary report into the allegations levelled against the HoD.
A Nehawu statement on the Polity site read: “A delegation of the National Education, Health and Allied Workers’ Union (Nehawu) led by the general secretary and the deputy general secretary met the Minister of Health, Dr Aaron Motsoaledi, and the management of the North West Department of Health in a quest to resolve the current impasse in the province. The meeting was at the request of the Minister.
“The meeting noted that last night (Wednesday 25 April, 2018) cabinet put the department under administration of national government and appointed a 11-member inter-ministerial team to try resolve the problems currently engulfing the department. As the national union, we welcome this gesture by government and hope it will reverse most of the anomalies that has characterised the department in recent times. We commit to work with the team in trying to resolve the impasse but we will not abandon our mass action until our demands are met.
“The meeting unanimously agreed that the current impasse is because of financial mismanagement by the department including corruption linked to outsourcing, procurement, servicing of medical equipment and human resources. The lack of good governance and proper use of finances has led to the near collapse of the public healthcare sector in the department. Patients have been on the receiving end of inadequate and sometimes non-existent healthcare services.
“Even before the strike action the province was dealing with shortages of medication, meals, beds etc. The strike action came as a result of anger from our members who have not received their bonuses because the department prefers to prioritise the invoices of service providers who in most cases inflates prices. We continue to hold a strong view that a forensic investigation on all the tenders awarded by the department including both Mediosa and Buthelezi EMS.
“A list of demands was handed over to the minister to study with a view of making substantial interventions. A follow-up meeting will be reconvened in due course with the aim to find a lasting solution to the issues pertinent to workers in the Department of Health. We also hope that the inter-ministerial team will help resolve the crisis engulfing the provincial administration as a whole because the issues of corruption and maladministration are not only limited to the Department of Health.
“The national union has an open-door policy and will always avail itself for engagements of trying to end the impasse. As part of the efforts of finding a lasting solution, we will also be engaging with civil society organisation in the Province.
“Our national executive committee meeting resolved to convene a National Day of Action on 16 May 2018 against the North West Department of Health. Failure to resolve the impasse between now and the 16th May will leave us with no option but to start mobilising towards that Day of Action.”
A damning report on the contract between Mediosa and the North West government was sent to the provincial legislature two months ago for tabling and adoption but has been mysteriously shelved. City Press reports that this is according to highly placed ANC leaders in the province, where communities and ANC alliance partners have made calls for Mahumapelo to step down on allegations of, among others, enabling Gupta state capture and tolerating corruption.
The legislature committee responsible for tabling items on the agenda had received a copy of the Mediosa report, but it has provided no explanation for why it had not been tabled.
The report says in February the provincial Health Department appeared before the joint inquiry on Mediosa by the North West provincial legislature portfolio committee on health and social development, as well as the standing committee on provincial public accounts. Health head of department Thabo Lekalakala revealed during the meeting that Mahumapelo authorised a trip to India for him and other officials to see Mediosa’s mobile clinic service.
The report says the final legislature report from the Mediosa probe recommends that: Lekalakala give a written confession on his trip to India which was sponsored by Mediosa; Lekalakala be suspended; Lekalakala produce a copy of the contract; the provincial treasury provide reasons why it transferred R50m to the health department on the eve of the R30m payment to Mediosa; the provincial treasury provide reasons how the health department could procure these services without its involvement; a legal opinion to be sought on the continued engagement with Mediosa; officials responsible for the Mediosa payment are named; a comparative analysis be conducted on services rendered by Mediosa and similar services that were offered by Samsung for free; and criminal charges be laid given Lekalakala’s “criminal confession”.
The report says it was further revealed that out of the R954 charged per patient for screening by Mediosa, R650 was to be paid to subcontracted companies from Dubai. The money would then be funnelled into the companies’ United Arab Emirates bank accounts, from where it would be used to fund the Guptas’ new business venture: Dubai Healthcare City.
The company said this week that “all allegations that have been levelled at Mediosa are patently untrue”. However, the legislature probe found that the department had appointed the company without following the supply chain processes. There was also a contradiction between Lekalakala and the MEC Magome Masike on the number of purchased trucks.
“The HOD mentioned that they have purchased four trucks and on the other hand the MEC only mentioned two, one delivered and the other one is still outstanding.”
The report says Mediosa had changed its name three times since 2015 and had been in operation for only three weeks in the Free State when it was visited by health officials for benchmarking.
The committee also flagged another contract with Buthelezi and High Care Emergency Medical Services, where money used was from the HIV conditional grant. The report says the provincial treasury also confirmed that “it is not allowed that the allocated budget for the HIV conditional grant be used for any other thing”.
Motsoaledi has reported, meanwhile, that Mediosa’s controversial mobile clinic contract with North West Health has been terminated, says an IoL report. Motsoaledi also confirmed that an investigation has been launched into the company’s contracts with the Free State and North West Health Departments.
The report says the minister’s words come days after Mediosa clarified its contract with both departments as well as its alleged links to the Gupta family. Mediosa claimed its contract with both departments was still in place and denied that illegal tender processes were followed in awarding them. Instead, the company said, they are still owed a substantial amount of money by both departments and that is why they are now in business rescue.
Motsoaledi is quoted in the report as saying that he was informed that the contract had been terminated during his latest visit to the province.
In March, Motsoaledi called on the North West Health Department to terminate its contract with Mediosa, saying the contract served no health service purpose for residents “except siphoning money from the health department to the Guptas”. “During my visit to the North West, I asked the (acting) Health Department HOD what the progress is and he told me that it’s been terminated.
“I asked how he it was terminated and he said that there is a clause stating that if services are not provided – as agreed – you can write to the company and give them seven days to explain themselves or resume their services. If they don’t, the contract is automatically terminated.”
Furthermore, while Motsoaledi maintained that the power to terminate the contract did not lie with him, he said he had written to the finance minister on 8 March, asking for an investigation into the contracts. Treasury would also probe whether the R30m paid in advance to Mediosa should be recovered as well as the Gupta-linked company’s contract with Free State.
The report says Mediosa came under fire after it emerged that North West health had paid R30m upfront and made a further R180m payment for the purchase of a single mobile clinic, while other service providers – who had done work for the provincial department – were told they would only be paid after the new financial year. “It’s the Treasury’s call to determine whether the money was paid unfairly… whether through the provision of an act or court of law, they must determine that legally,” Motsoaledi maintained.