The Democratic Alliance (DA) has called on President Cyril Ramaphosa to establish a judicial commission of inquiry into the state of public healthcare, after its random survey of hospitals and clinics revealed significant gaps in patient care. Business Day reports that chronic under-staffing, equipment shortages and long waiting times characterised many of the facilities the DA visited. Its observations tally with the problems highlighted by provincial health MECs in recent presentations to Parliament, which revealed that even the tightly managed Western Cape Health Department was struggling to cope with demand.
“Public health facilities are no longer places of healing. They have become death traps for the poor, who have no other options available to them,” said DA spokesperson Refiloe Nt’sekhe. “While inspecting the RK Khan Hospital in KwaZulu-Natal, we learnt that waiting times for CT (computed tomography) scans are three months, while the next available mammogram appointment is in 2019.”
Emergency medical personnel in Mpumalanga told the DA that they were using their own money to buy vital equipment such as blood pressure monitors, while in the Northern Cape staff at Kimberley Hospital complained about a lack of basic supplies such as toilet paper.
The DA’s Gauteng health spokesperson Jack Bloom acknowledged achievements such as the roll-out of HIV and tuberculosis treatments, but said many patients were being short-changed. “There are pockets of excellence in Gauteng where staff are doing their best and patients get top-rate care. But the problem is the waiting times: you can wait five years for hip surgery at (Chris Hani) Baragwanath,” he is quoted in the report as saying.
Gauteng had excellent academic hospitals, which attracted patients beyond its borders, increasing pressure on a stretched service. The DA had written to Ramaphosa requesting a judicial commission of inquiry as it would have the scope and power to get to the bottom of the mismanagement and corruption plaguing public health, Bloom said.
The DA said its plan for universal healthcare offered patients a better deal than the government’s proposed National Health Insurance (NHI). Published in 2016, the plan promises universal healthcare quicker and cheaper than NHI. It proposes scrapping medical aid tax credits and using the money to improve public healthcare and subsidise medical scheme membership for more people.
“Our health plan is the most practical approach to universal healthcare as it aims to keep what should be kept, fix what should be fixed and smartly extend services that should be extended within the limits of the national purse,” said Nt’shekhe.
Meanwhile, the report says, the National Education, Health and Allied Workers Union is planning mass action in Limpopo after the province’s health department failed to pay staff R160m in performance bonuses for 2016-17. The union’s Limpopo spokesperson, Jacob Adams, said the department had offered to pay R90m. “We told them to go to Treasury (and ask for more).”
KwaZulu-Natal shadow MEC Dr Imran Keeka said KZN health care was also in a crisis, with one of the biggest problems being lack of accountability, says a Polity report. He said the MEC who was found to have violated human rights was still heading the department and might be the next premier of the province.
Keeka said rats were seen feeding on a corpse at one of the hospitals and at another hospital, monkeys were seen throwing stones at doctors through the roof. "There's a shortage of chronic medication and the minister denies this, a shortage of vaccines and broken equipment. KZN has vacancies for staff amounting to over 8,000." Keeka added that there were a number of medical buses that cost millions that couldn't be used because of licensing issues.
The Limpopo shadow MEC, Langa Bodlani, added that management at the province's hospitals was in chaos and that before any medication could be bought, some outstanding bills still needed to be paid. "Two mothers and unborn babies need to share a bed. In other hospitals we found they didn't have a Panado pain killer for babies and it's been going on for months."
Bloom said the R46bn Gauteng budget was poorly spent. "Any delay in cancer treatment can result in death. The budget is so badly spent that we have broken machinery and they could get more capital spending if they could prove that they could spend it. In Tembisa there's patients on the floor."
Bloom said in the report that almost all the hospitals in Gauteng had broken equipment. "You would've thought after Esidimeni they would see the warning signs, they don't plan."
Nt'sekhe said it was a disgrace that patients were given rotten food in Limpopo. "The money is there but it's not used properly, the Western Cape has the best running health system and is run by the DA."
A summary of the DA’s report is carried in The Times.
1. Chronic staff shortages and long waiting times: All the facilities lacked staff in critical positions. At the Bongani Hospital in the Free State‚ they found that the facility only had one nephrology sister to attend to patients suffering from kidney diseases. This was despite health norms and standards indicating that hospitals should have nine.
While inspecting the paediatric ward in Taung District Hospital in North West‚ the DA found that there was no qualified resident paediatrician to treat children and that the ward is severely understaffed‚ including nurses‚ cleaning staff and cooks.
Tembisa Hospital in Gauteng only has 40% of the nurses that are required‚ they found. According to international norms and standards‚ the hospital should have at least 628 more nurses to provide proper health services to patients.
The Soweto-on-Sea Clinic in Port Elizabeth is only visited once a week for four hours by a doctor while the clinic services 3‚000 patients per month. This was mirrored in the visit to KwaZulu-Natal’s St Mary’s and RK Khan Hospitals‚ where KZN’s Health Department has vacancies of 5‚926 critical staff.
2. Equipment shortages: At the RK Khan Hospital in KZN‚ the DA found that the X-ray department still has no defibrillator despite MEC Sibongiseni Dhlomo being alerted in 2014 that it was broken.
At Bongani Hospital in the Free State‚ the hospital has nine theatres but only three are operational due to ineffective equipment. The renal plant has not been operational since its inception.
3. Oncology crisis: There is not a single radiation oncologist in Limpopo or Mpumalanga. At the RK Khan Hospital in KZN‚ waiting times for CT scans are as long as three months while the next available mammogram appointment is in 2019.
4. Shortages of consumables and medicine : While inspecting various hospitals in Nelspruit and Barberton in Mpumalanga‚ Emergency Medical Care personnel told the DA that they have resorted to buying vital medical equipment such as high blood pressure machines out of their own pockets due to the department failing to provide such equipment.
In the Northern Cape at the Kimberly Hospital‚ there are shortages of basic supplies such as toilet paper.
For the past two months at Maphutha Malatji Hospital in Limpopo‚ the pharmacy has not had an iron supplement drug‚ a vital medicine for pregnant women and HIV patients as well as Panado Syrup – a painkiller for children.
At St Mary’s Hospital in KZN‚ doctors and nurses complained of shortages of simple and everyday disposables such as syringes‚ needles and "jelcos" which are used for intravenous access to set up drips.
5. Negligence and claims: Medical negligence claims have led to large payouts which have put a strain on the health budget. Last year‚ the Gauteng Health Department had R18.6bn in negligence claims‚ Eastern Cape had R16.7bn and KZN had over R9.2bn.
6. Transport and ambulance related issues: In a Mpumalanga hospital‚ only two out of four ambulances were operational. The other two had mechanical problems. “Many of the ambulances had travelled more than 400‚000 kilometres and posed a risk to patients and medical personnel‚” the inspection team said.
7. Infrastructure/Lack of Maintenance: The department’s Annual Report shows that out of the 44 community health centres which were to be constructed and revitalised‚ only 22 were completed‚ the DA said. Out of the eight hospitals that were supposed to be constructed or revitalised‚ only three were completed.
“No maintenance has taken place at the Bongani Hospital since it was built 20 years ago. Shockingly at our visit to the Schoemansdal Clinic in Mpumalanga‚ the toilets haven't been working for a very long time causing embarrassment to both patients and staff. The pit toilet which is currently being used leaves an unbearable stench which is aggravated by rain.”
8. Mental health crisis: “Following the Life Esidemeni tragedy in Gauteng‚ government is yet again failing to stop future mental health tragedies in South Africa‚” the politicians asserted.
At Tembisa Hospital‚ psychiatric patients are kept for long periods of time as there are not enough beds for them at Weskoppies Mental Hospital – they should only be at Tembisa Hospital for 72-hour observation before they are discharged or sent to a longer-term facility.
While at Life Esidimeni in Limpopo; rather than increasing their budget to assist with the maintenance of the facility‚ a decision has been made to halt the funding of the non-profit and for the Limpopo Department of Social Development (DSD) to take over the management and functions of the centre.
Given the bad track record of the DSD in Limpopo‚ its financial constraints and record of mismanagement‚ every effort must be made to ensure that the mental health centre in Shiluvana remains in the hands of Life Esidimeni.
“The findings from our #HospitalHealthCheck oversight inspection campaign makes it clear that all is not well in our public health sector. Although there are financial constraints facing the Department‚ it is evident that at the heart of our failing health system is maladministration (and) poor oversight‚” Nt’sekhe is quoted in the report as saying. The party offered to assist national government tackle these issues.
Gauteng Health MEC Gwen Ramokgopa says that her department is working to fill vacant posts in clinics and hospitals around the province. Ramokgopa says in an Eyewitness News report that many have been led to believe that there’s a moratorium on filling vacant posts and that the department is on the brink of collapse.
She says that the Gauteng Health Department will see an injection of doctors and nurses to alleviate the growing pressure at facilities. "The post filling committee has authorised the filling of over 500 posts. Our focus is to make sure that we only fill critical posts." Ramokgopa says that any reports that vacant posts will not be filled are untrue.
The MEC says that the department is experiencing high demand for services due to a growing population.
[link url="https://www.businesslive.co.za/bd/national/health/2018-06-14-sas-dire-healthcare-system-needs-the-das-our-health-plan/"]Business Day report[/link]
[link url="http://www.polity.org.za/article/da-says-sa-health-care-system-on-the-brink-of-total-collapse-2018-06-14"]Polity report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-06-14-eight-alarm-bells-at-south-african-state-hospitals/"]The Times report[/link]
[link url="http://ewn.co.za/2018/06/18/gauteng-health-dept-working-to-fill-vacant-posts-at-clinics-hospitals-mec"]Eyewitness News report[/link]