Stung into action by mounting warnings of systemic collapse, Health Minister Aaron Motsoaledi in the past week despatched 200 ministry officials to hospitals nationwide, to address management failures.
News24 reports that when outlining his plan of action, Motsoaledi attributed the “distressed” state of the healthcare system to the exponential growth of the burden of disease as a result of a huge increase in noncommunicable diseases such as diabetes, high blood pressure and cancers.
He said that, since Tuesday of last week, 200 officials from the department’s head office had been sent to hospitals across the country to help with management issues. “We are painfully aware of the poor management skills in most of our hospitals. We are also aware of the negative attitudes of some staff members in quite a number of our facilities … While we have mentioned the long waiting times, brought on by the high demand for health services, we also believe that, with good management skills and planning, some of these waiting times can be markedly reduced,” he said.
The report says the minister also spoke about the department’s success in upscaling its TB and HIV programmes, saying these were among the biggest in the world. But he conceded that there were a plethora of problems, such as overcrowding and a chronic shortage of human resources.
To address the understaffing issue, Motsoaledi announced that 223 vacancies would be filled this month in North West, at a cost of R150m.
“Our other problem is Gauteng, which carries the burden of all former Transvaal provinces and even the whole of the Southern African Development Community. I’ve made it known to Gauteng that, no matter how tough it is, we cannot afford not to fill vacant posts in health,” he is quoted in the report as saying.
For the oncology crisis gripping KwaZulu-Natal and Gauteng, the minister has allocated R100m to deal with the backlogs.
Cosatu had earlier called on President Cyril Ramaphosa to sack the health minister over the state of public healthcare. The Times reports that the trade union federation has blamed Motsoaledi for the collapse of the healthcare system saying it has reached crisis level. The ANC-aligned federation accused the minister of “denialism and scapegoating”. Their call comes amid renewed calls from opposition political parties for intervention in public healthcare.
The report says Cosatu played a role in Ramaphosa’s rise to power as it was one of the alliance components that backed his leadership. But the federations’s influence over the president is yet to be tested. This move may also spell the end of the Nasrec honeymoon as Motsoaledi was also one of Ramaphosa’s loudest cheerleaders.
A go-slow and community strike‚ led by Cosatu-affiliated Nehawu‚ in the North West over problems at that province’s department of health led to national government intervention.
Cosatu spokesman Sizwe Pamla is quoted in the report as saying that poor communities were paying the price for a total collapse of public health. “He is the only minister who has been allowed to stay in one position for close to a decade‚ without being reshuffled. He had ample time to set up a vision and implement it over the last nine years but he has spectacularly failed‚” said Pamla.
He said although health was a provincial competency‚ it was “the centre that has collapsed” leaving the provinces feeling their way in the dark. “(Motsoaledi) has never taken responsibility for anything from the problems with the NHI‚ South African Nursing Council‚ Health Professionals Council of SA‚ Esidimeni tragedy‚ listeriosis outbreak and other litany of problems that have engulfed the sector over the years‚” he said.
Pamla said Motsoaledi paid lip service to non-racial and unbiased universal health coverage. “The amount of money that has been spent on the public health system over the last years has not delivered the desired results. We support the decisions that have been taken by national government over the years to intervene and rescue the health system in many provinces but the problems start with the national department of health under his leadership‚” added Pamla.
He said in the report that Cosatu would be joining its unions in the health sector – Denosa and Nehawu – on their campaign push-back against the deterioration in the health sector.
The Economic Freedom Fighters (EFF) has repeated its call for the removal of “the corrupt ANC government” from power in light of the crisis in public healthcare, reports Polity. The report says the EFF has dismissed Motsoaledi’s recent statement that the public health sector was not on the verge of collapse.
“The EFF is utterly shocked at Motsoaledi’s denialism of this reality, and this will lead to the death of many citizens. At this rate, he will very soon assume a title of Dr Death because of his denialism. You can never solve problems if you keep denying it’s intensity and severity as Motsoaledi does,” the party said.
The report says the EFF has declared that 2018 is the Year of Public Healthcare.
The EFF added that the crisis at the Charlotte Maxeke Hospital in Johannesburg had been looming and was not a surprise because the healthcare system “has been in shambles for quite some time now”.
“The ambulances in KwaZulu-Natal and in Limpopo are not working, if they are the service is poor. In the Eastern Cape, Gauteng and North West there have been numerous reports on the shortage of beds, poor medicine supply or a total shortage thereof, long queues and rude staff; that humiliates and condemns our people to indignity. Patient’s rights are not respected and their safety is not even a consideration in many hospitals,” alleged the EFF.
The report says the EFF went on to fault Motsoaledi for blaming the provincial administrations for not fixing the public healthcare. “If Motsoaledi thinks centralising power is a solution, by now, he should have already proposed the necessary legislative changes,” suggested the EFF.
Among the issues that the EFF says require urgent attention are the high levels of corruption in the Health Department, public health institutions having no basic facilities, buildings deteriorating, and broken machines.
“There is a shortage of doctors and nurses, and community health workers and lay HIV counsellors earn R2,500 a month. The maladministration and mismanagement of funds is deplorable,” the party concluded.
According to the report, the EFF declared that Motsoaledi had presided over the worst healthcare collapse since the dawn of democracy.
Cosatu’s remarks make reference to Motsoaledi’s repeated explanations that current legislation does not allow him to intervene in provincial health crises. “I only come in as a sort of post-mortem, because there is no mechanism for me to intervene before these things happen. Like human resources, procurement is controlled provincially,” he is quoted in a Bhekisisa report as saying.
Instead, the minister explained the only “tools” he can use to get provincial health departments to work with him is “goodwill”. “Intervening sometimes does happen, but not with the full backing of the law. It happens maybe with some political gravitas, or goodwill, or humanity, or a sense of co-operation.”
Political analyst Ralph Mathekga said in the report Motsoaledi is right, the law gives him very little power in provinces. Until now, he said, the ANC has had an implicit “gentleman’s agreement” between its officials in Pretoria and those in the provinces to keep the peace. An agreement, he warned, that could be on the wane.
Until the national Health Department has more say in how provincial health departments function, Motsoaledi is quoted in the report as saying he’s largely powerless to prevent provincial health crises.
The report says he explained to editor Mia Malan:
Q: “Are your hands tied when it comes to provincial emergencies?”
A: “Whenever there is a crisis, like with Life Esidimeni or the oncology crisis in KwaZulu-Natal, I am called in to solve them. But I don’t have the legal mechanism to prevent these crises from happening, because Health MEC’s don’t report to me; they report to their respective Premiers.
“Interventions sometimes do happen, but it happens without the full backing of the law. It happens maybe with some political gravitas, or goodwill, or humanity, or a sense of cooperation.
“You can’t run a country by hoping.”
Q: “Why is corruption so rife in procurement?”
A: “In the health department, you have to buy everything: medicine, linen, food, cleaning services, laundry services. In every corner you look, there is something that needs to be bought.
“I think that’s what causes our problems. I won’t shy away from it.
“Procurement is a bone of contention, especially in the North West. I (the national health minister) only come in as a sort of a post-mortem. Under no circumstances would I have agreed on a procurement like (the R190m illegal tender to the Gupta-linked) Mediosa to take place. But I am forced to come in when it is already too late.”
Q: “How do politics affect service delivery?”
A: “As a minister, you have no say in who gets hired and at what level. Human resources is a purely provincial function, which is exercised by the Premier – not even by the MEC.
The health minister is an executing authority only for those people who are hired at a national level. But for all the others who are working in hospitals, that’s where delivery is, executing authority is the MEC.
“For example in the North West, I pleaded with the Premier not to appoint the current head of health (Thabo Lekalakala). But he insisted, and there was no law under which I could stop him. I knew Lekalakala couldn’t run a directorate.”
Q: “What’s the solution?”
A: “Our dreams of a National Health Insurance (NHI) will never happen if our provincial health systems aren’t working. In the NHI white paper, we are proposing that 12 acts need to be amended. We are targeting the issues of human resources, financial management and procurement specifically.”
Q: “What else has to change for the NHI to work?”
A: “One of the reasons there is good quality in the private sector is because the person who buys services is not the same as the one who provides them.
“In the public sector, the purchaser and the provider is one person, the MEC. The MEC is given a budget by the treasury to provide health services to citizens. The MEC must go and hire nurses, make sure there is equipment, and then go purchase the services for the citizens the same services he has provided.
“Whether the services are good for the citizens or not, it doesn’t matter – nothing pushes you.
“Under the NHI, districts will be able to send their patients to where the best service is. That set-up will create more competition and credibility, and force people to jack up (their services).”
South Africa is facing the risk of an even more severe shortage of specialist doctors – a scenario that would hit the state and private health sectors hard‚ and one that has the Health minister “worried”.
The Times reports that in an unprecedented statement‚ the South African Committee of Medical Deans has publicly stated that the poor state of provincial health departments “destabilises” academic training of doctors. It called for more provinces to be put under national administration and for public hearings into the state of government healthcare.
The head of the committee‚ Professor Martin Veller‚ who is the University of the Witwatersrand’s medical dean‚ said fewer registrars – who are specialists in training – are likely to be employed by the state in Pretoria and Johannesburg after they qualify. The report says this is because positions have been frozen by the cash-strapped Gauteng Department of Health‚ as detailed in a letter sent to every hospital head.
Secondly‚ specialists are currently not being hired by the state for the same reason. This comes as others resign‚ so there could be too few to train registrars.
The report quotes an insider as saying that they had heard there was a planned 50% reduction in Wits’ training positions for future specialists. These are positions for training specialists such as anaesthetists‚ gynaecologists and oncologists. These specialists in training are already doctors who work at Chris Hani Baragwanath Hospital and Charlotte Maxeke Hospital, as well as many smaller hospitals around Gauteng.
A doctor explained: “The problem with not training enough registrars is that at teaching hospitals‚ registrars provide the majority of specialist services.” Teaching hospitals include Helen Joseph Hospital and Steve Biko Hospital, in addition to Charlotte Maxeke and Baragwanath.
The doctor explained what fewer registrars meant for patients: “Without registrars‚ patients don’t get a specialised level of care. As such‚ fewer registrars means less service delivery and ultimately in the long term‚ fewer trained specialists – of which there is already a massive shortage.”
A doctor in the state service said: “I would estimate that by 2019‚ Gauteng will be 40%-50% down in absolute number of qualified doctors employed in the state. That’s going to collapse an already terrible system further.”
Interviewed by Chris Barron in a Sunday Times report, Dr Mzukisi Grootboom, chair of the South African Medical Association, which represents doctors, said the public health system is collapsing.
Q: “Aren’t you being a bit alarmist?”
A: “That was a word used by the ombud.”
Q: “Is the ombud being alarmist?”
A: “I don’t think so, no.”
Q: “The health minister says it’s just overcrowded?”
A: “No, it’s far from that. Yes, there’s overcrowding, but over and above that there has been an exodus of doctors because of a decision not to fill certain posts.”
Q: “The minister says doctors are not applying for these posts because they’re too picky?”
A: “That’s not what I’m being told. The minister’s trying to say the situation is manageable.”
Q: “Is it?”
A: “No, it’s not. For the average person at state hospitals and clinics the challenges are huge.”
Q: “Why are there so many medical malpractice suits?”
A: “That’s the outcome of a system where there is no clinical governance. When there is a collapse of the system this is one of the symptoms. There are no supervisors, no consequences, nobody in a leadership position with experience to guide doctors and nurses.”
Q: “Because these posts are not filled?”
A: “Precisely. In many instances hospitals are not filling those posts.”
Q: “The minister says doctors don’t want to work in rural clinics?”
A: “He’s a minister in denial. We get reports of youngsters who want to stay in these rural areas after finishing their community service, but there are no jobs for them.”
Q: “Aren’t doctors leaving the public health system because they make more in the private sector?”
A: “They’re leaving because the environment, the system, is not encouraging them to stay. Broken equipment, lack of support structures and the kind of development they need to have; bad management across the board.”
Q: “What’s the answer?”
A: “We need to have an honest discussion with the minister about the problems.
Q: “Why haven’t you had that yet?”
A: “He’s avoiding that. We started trying way back when Kgalema Motlanthe was acting president. We never made any headway.”
Q: “You’ve never met with the minister?”
A: “Only with his officials. Part of the challenge is the devolution of powers, because it is the provinces that are running the health services.”
Q: “So it’s not the minister’s fault?”
A: “I’m not saying that at all. It’s his overall responsibility to make sure that those departments work properly, not to use that as an excuse when we raise these issues.”
Q: “Does anything come of your meetings with the department?”
A: “Lots of promises, but nothing is resolved.”
Q: “The minister says national health insurance is the answer?”
A: “You cannot start a system if you don’t have the basic requirements: a proper level of staffing, accountability and everything that goes with that – systems that run properly and are responsive to the needs of the people. We aim to have this national health service, but we can’t deal with the basic issues we need to deal with to make delivery accessible to our people: the clinics, hospitals, community health centres.”
It’s a waiting game – shuffling between a cold hospital bench and steel chairs in a winding queue to receive help. And it’s a hard game on a winter morning, more so for the ill. City Press reports that it joined the queues at the Far East Rand Hospital in Springs, Gauteng, one of only five health facilities out of 649 across the country that the Office of Health Standards Compliance inspected and found to be compliant with the health department’s norms and standards. It scored a grade A compliance rating of 80%.
The report says the office’s latest inspection report was tabled in Parliament last week, the day Health Minister Aaron Motsoaledi briefed the media to address increasing claims of an impending “collapse” of the country’s health system.
Far East Rand Hospital has a chequered history of overcrowding and poor sanitation in one of its wards. To see if things had improved, the report says it joined all the queues – for patients to open or recover their files; for admission; at the out-patient department; and to get medication.
The report says: “In the triage queue at 10:00, we waited for an hour for a nurse to assess us. Patients shuffling along the benches became irritated as nurses routinely went out for 10-minute breaks without informing those who waited about when, or if, they would be back. But they were otherwise helpful, and the surroundings were clean and the floors were routinely mopped.
“As a nurse helped a visibly confused and difficult patient emerging from the X-ray department, an elderly patient behind us complained of having waited in the wrong queue before reaching the triage line.”
“The hospital is well signposted and there are information boards on illnesses, lists of the institution’s values, the names of its managers and information about patients’ rights.
After assessment at triage, it was a 40-minute wait in another queue to open a file before we reached the front desk, where the process took 15 minutes. Then it was off to the outpatient department, where City Press, Patient 64, was sent for a blood pressure check. But in the small cubicle, the nurse saw in the file that this had been done already and sent us to the queue to see the doctor.
“At 14:30, four-and-a-half hours after we started, the queue lined the corridors leading to the consultation rooms. We left because it became clear that there were still many more hours of waiting ahead of us.”
The report quotes Sisi Dhlamini (41), who gave birth at the hospital earlier this month, as saying she was satisfied with the service she received there. “I started coming here when I was seven months pregnant and the doctors have treated me well. The ward I was in was clean and we received all the basics we needed. The nurses changed our linen and we had hot water,” she said.
“The only thing I could say was a bad experience was the food. Sometimes there was no sugar and we’d have to drink tea without sugar. And the bread was dry and had no butter. Otherwise, the treatment was fine.”
Pitso Kokwano (63), who was admitted for a few days last week and returned for a check-up, said he was also treated well, but that his family had to bring him a blanket.
Russell Rensburg, programme manager for health systems and budget at the Rural Health Advocacy Project, said the (health) sector was in “shock and crisis”, and everyone needed to work together to find solutions instead of only raising the alarm. “It feels like we’re pointing at a kid in the corner who has wet his pants and we are laughing at him. We too – as citizens – have agency. A crisis is an opportunity for imagination and innovation. We need to relook at how we do things. We have an opportunity to reform and recreate.”
Rensburg said the sector needed an “honest diagnosis”. “We need to look at the capacity of human resources in the sector. How are professionals being spread out across facilities? From there, we can look at our infrastructure. Do we really need more hospitals, or do we need resources within the hospitals and revitalisation?
“We need to look at whether we are spending money correctly and on the right things. We’ve seen a lot of under-allocation of funds for district health services and a lot of money spent on procurement, which manifests in situations such as the Mediosa scandal – paying enormous amounts for services we don’t need or that aren’t used.”
The report says Sasha Stevenson, head of health for non-governmental organisation Section27, agreed with the assessment that the system was in crisis. “However, one of the difficulties is that the word is overused and often loses its meaning. Yes, while there are things going right, such as the massive antiretroviral programme, there are still enormous issues that continue.”
One such problem was filling critical posts, she said. “If you don’t have enough doctors and nurses, service delivery is impacted and that’s where medico-legal claims come in because facilities are under pressure. We’re often focused on the minister and what he should do, but we also need leadership from a provincial level.
“Provincial MECs need to step up and recognise that rampant corruption and leakage of funds has a direct impact on service delivery. It’s important that we stop that leakage of funds.”
Rensburg said the health system needed reform. “We need to start changing the narrative. Let’s look and see how we can change things and then develop a system we want.”
Parliament heard last week that the Western Cape’s biggest hospital is buckling under the demand for its services and is so dilapidated that it needs to be replaced, reports Business Day.
Tygerberg Hospital is an academic hospital in northern Cape Town, and serves patients referred by less-specialised facilities. It was built in 1978 and has such an extensive maintenance backlog it would cost more to fix it than replace it, the Western Cape head of health Beth Engelbrecht told Parliament’s portfolio committee on health.
“Tygerberg Hospital is under severe pressure. The CSIR (Council for Scientific and Industrial Research) assessed it and said the hospital must be replaced. We have spent R700m on maintenance in recent years and you walk through the hospital and you can’t see it – it is sewerage lines, gas lines and water lines,” she said. It would cost an estimated R10bn to replace the tertiary services component of Tygerberg Hospital alone, said Engelbrecht. “We are motivating with the national department to assist us financially,” she said.
The report says Tygerberg’s infrastructure needs were the worst among the province’s central hospitals, but many other facilities needed maintenance and new equipment, she said, noting that the infrastructure backlog was R1bn. Western Cape Health Department chief operating officer Keith Cloete told MPs that the demand for emergency orthopaedic surgery at Tygerberg recently rose to more than 100 cases a day, with a knock-on effect on patients who were waiting for elective surgery. Many of the emergency cases were due to violence, he said.
Crime and violence were not only driving up the number of emergency cases across the province but were also affecting the Health Department’s ability to render services, he said. The increasing number of attacks on ambulances was giving officials sleepless nights, he said. “It is getting worse. There is an attack on an ambulance every three days,” he said. The report says he presented data showing that there had been more attacks on ambulances in the five months to May (40) than there had been in the whole of 2017 (36). The surge in attacks, which included 12 in May alone, was a reflection of society as a whole and therefore beyond the scope of health to tackle on its own, he said.
Engelbrecht said patients’ biggest complaints were about long waiting times, and staff were under “terrible pressure” to meet their needs. Almost a quarter of the complaints the department received from patients related to waiting times, she said. “We recognise that people wait for services, they wait long, they wait hours. But we really do try to do our best with what we have,” she is quoted in the report as saying.
A site inspection by the South African Human Rights Commission (SAHRC) at Charlotte Maxeke Johannesburg Academic Hospital oncology department has painted a worrying picture of the public hospital’s service… it’s functional, but only just, says a Daily Maverick report. Nearly 500 cancer patients are said to be waiting for cancer treatment at the hospital. But they are unlikely to receive it any time soon as the hospital’s oncology unit is dealing with a staffing crisis and broken radiation machines
The report says it was this claim coupled with reports that the oncology department was on the verge of collapse that prompted the SAHRC to visit the hospital. In light of these allegations, the commission “commenced its own initiative investigation in order to test the veracity of the said allegation”, said SAHRC provincial manager, Buang Jones.
The report says the visit comes a week after workers at the hospital protested by blocking entrances with burning debris, throwing rubbish around and turning patients away, unattended and untreated. Staff – doctors, nurses, cleaners and general workers – went on strike to demand payment of their performance bonuses for the 2016/2017 financial year.
The report says it also follows an earlier visit to the Steve Biko Academic Hospital for an oversight inspection after similar allegations of a dysfunctional oncology unit surfaced. Despite the claims of a dysfunctional unit at Charlotte Maxeke Hospital, the unit was functioning normally when the SAHRC visited.
According to the hospital’s CEO, Gladys Bogoshi, the unit has treated 3,189 cancer patients – including 1,330 breast, 1,508 cervical and 368 lung, head and neck cancers – from April to May. She said the main challenges the hospital faces include old and worn-out machines that have reached their lifespan. “One machine is due (to be replaced) this year and another will have to be replaced in 2019,” said Bogoshi. “Some of units were relocated from Hillbrow Hospital when it closed in 2006,” said Bogoshi.
The report says all the machines were installed by Siemens, an appliance company which no longer makes radiation machines in the country, but the hospital has a longstanding agreement for the company to maintain and fix them when needed. “We have a maintenance contract with Siemens which ends in 2022,” said Bogoshi.
Meanwhile, the report says, the hospital has been struggling to fill two vacancies for oncologists. With three full-time doctors in the department, the CEO acknowledged the strain these vacancies put on the staff, saying many worked late at night to help patients. “We have tried everything. We have put the post in international radiation journals but no one is interested in a full-time position,” said Bogoshi.
Jones praised the hospital for the work they do with the limited resources. He acknowledged the challenges the hospital was facing and said further research would be done by the SAHRC to find solutions to the situation. “We still have to make a proper and comparative assessment,” said Jones.
Although the situation seemed grim, the report says Bogoshi reassured the SAHRC that the department is not on the verge of collapse as reports have alleged. “I would not call it a crisis because they are doing their job and are working. It would be a crisis if patients were not receiving any treatment,” said Bogoshi.
The SAHRC has described the crisis happening at public health facilities in Limpopo as in need of urgent intervention before the health system collapses. Health-e News reports that expired medicines and rotten food found at Polokwane Provincial Hospital and patients being forced to wait many hours before receiving help at Kgapane Hospital in Mopani district are among the issues that need to be urgently addressed and have been blamed on poor leadership.
Polokwane Provincial Hospital, regarded as the best in the province, is marred with problems ranging from expired medication, a shortage of consultation rooms, a poor filing system, laundry machines that don’t work and expired food in the kitchen.
The report says the SAHRC paid a surprise visit to the facility and discovered expired food and medicines that were going to be given to patients. A poor filing system means that patients are required to open a new file every time they visit the hospital, as the staff cannot locate old files. Hundreds of patients seeking better health care services from specialists are transferred to the Polokwane Provincial Hospital from regional hospitals within the province. Patients are forced to consult with doctors in the open, in front of other patients, due to the shortage of consultation rooms.
“It is a violation of human rights when patients are forced to reveal their illnesses in front of others. Imagine a chronically ill patient being forced to consult in the open. It is something we cannot allow to carry on. The filing system is also non-existent and doctors are unable to find patients medical histories,” said Victor Mavhidula, SAHRC commissioner in the province.
He added: “We also found expired medications and old food at the hospital which raises a lot of questions about the leadership. The laundry machine is also not working. If we allow the provincial hospital to collapse we will be saying that the public health system in the province has collapsed, as it is regarded as the best hospital in the province. Something needs to be done urgently to address the situation and we will not rest until everything is in order.”
The report says the SAHRC will be presenting its findings at Polokwane Provincial Hospital to the MEC of Health, Dr Phophi Ramathuba, in order to request a high-level intervention.
During her visit to Kgapane Hospital in Mopani district following several complaints from patients which circulated through social media, the MEC of health in the province, Dr Phophi Ramathuba blamed the poor treatment of patients on poor leadership at the hospital. She has since introduced a new interim management as a temporary solution.
She has also asked patients to visit their local clinics first before going to hospitals.
The SAHRC said that progress had been made by the KwaZulu-Natal Health Department in implementing the commission’s recommendations on the state of oncology in the province. News24 reports that this followed a site inspection at Addington Hospital by provincial officials. The delegation was met by hospital CEO Mthetheleli Ndlangisa and the head of the oncology unit, Thabisile Hlengwa.
The commission noted that, in complying with its recommendations, the department had successfully repaired one Linear Accelerator (VRALA) machine. “The Commission can confirm that the first patient was treated on the 5th June 2018, using this machine. In addition, some of the staff members from Addington Hospital, who were stationed at Inkosi Albert Luthuli Central Hospital, have returned to Addington Hospital in order to provide services to oncology patients,” the commission said.
The hospital had also secured the services of one oncologist. It would also continue with the public–private partnership (PPP) agreement with Wits Consortium which supplies oncology services to the hospital on a weekly basis.
According to the report, the commission said it was happy that the national government was involved in addressing critical issues of access to health care and would like to urge the KwaZulu-Natal Health Department to speed up the implementation of the remaining recommendations.
The SAHRC said it would continue monitoring the hospitals and the oncology situation in KwaZulu-Natal and other provinces to ensure that the right to access health care services was promoted and protected.
The Times report
The Times report
Sunday Times report (subscription needed)
City Press report
Business Day report
Daily Maverick report
Health-e News report