KwaZulu-Natal Health has one month to give clear timelines toward resolving its many problems, Parliament’s select committee on social services said. “The committee has instructed the provincial health department to provide… a detailed plan, with timelines, on how these challenges will be overcome within the next month,” chair of the committee Cathy Dlamini is quoted in a News24 report as saying.
When it came to oncology care in the province, the committee welcomed an interim public private partnership arrangement. “Private oncologists, medical officers, radiotherapists and oncology nurses (are) to deal with the oncology backlog,” said Dlamini. “The committee further welcomed the fact that besides the two broken oncology machines at Addington Hospital, cancer patients still receive other cancer treatment at other centres in the province.”
Interventions were also being made by the National Health Department.
Oversight visits were conducted at Addington Hospital and the Cato Manor Community Health Centre. The committee also met with the Health MEC. Problems uncovered included job vacancies and a low skills base, supply chain management, infrastructure, and a lack of equipment and underfunding.
“The committee was horrified to learn that… at Addington Hospital the mortality rate within the maternity ward was high mainly because of lack of staff. While we acknowledge that the ward at Addington deals with primarily high-risk pregnancies, it is unacceptable that the quality of services has been compromised due to inadequate staffing,” said Dlamini.
“The committee will await the requested reports and will continue to monitor implementation of recommendations made by the committee.”
At the recent Addington site visit, News24 reports, the committee observed and questioned staff at the neo-natal and paediatric wards.
Doctors in the neo-natal ward spoke of how beds in the ward had to be reduced because of a lack of staff. “We had to reduce the number of beds because of the shortage of staff. We depend on registrars who are trainees to come through and supplement our staff,” Dr Sudhir Prithipal said.
Dlamini said that it was unacceptable that beds had to be reduced because of the shortage of staff. “It is sad that people will be suffering because there is not enough staff. We need to do something about this.”
The report says while visiting the paediatric ward, the committee spoke to a visibly tired Dr Noxolo Mbadi, who highlighted a number of challenges in the ward including staffing challenges. She said that there were not enough nurses and doctors. The unit only has four doctors but needs eight to operate optimally, she said.
Dlamini said she herself had been depressed by the situation at the ward. “I am not promising anything but we will try our best to ensure the minimum is there. Thank you for staying with all the challenges you have.”
Mbadi is quoted in the report as saying that doctors were not leaving because they wanted to, but because of working conditions. “They are overworked and cannot do much in terms of their social affairs. There were doctors who wanted to further their careers and specialise, but they do not have time to study.”
Dlamini affirmed that the committee would “do all we can” to assist Mbadi and other medical professionals at the hospital.
Minister of Health Aaron Motsoaledi has, meanwhile, appeared before the Parliamentary portfolio committee on health to respond to the South African Human Rights Commission’s damning investigation into the treatment of cancer patients in KwaZulu-Natal (KZN).
Groundup reports that he identified weaknesses in the processes of provincial human resources and anomalies peculiar to KZN in its procurement supply chain system as the underlying causes. Posts are not filled as fast as they are vacated. The effect is that the pressure created by staff shortages drives newly qualified staff to other departments of health or into the private sector. He also identified the “disinclination by senior management in the province to delegate recruitment functions”.
He said the department had been made aware of the problem a month before the situation was brought to the attention of the public in June by the SAHRC. The report says in May, 2017 the minister dispatched a team from his department, led by the director-general, to visit the province to investigate the problem. This was in response to a march on 5 May by doctors belonging to the KZN Coastal Branch of the South African Medical Association (SAMA) who had protested to highlight the conditions under which they were working in the province. They handed over a memorandum to the KZN authorities which was forwarded to the department’s director general.
The minister also expected a list of minimum critical posts to be compiled, costed and handed over on that day to the MEC for Finance and the Premier for consideration. The director general of the national department is expected to be present for the presentation.
The report says Motsoaledi’s report listed urgent interventions. Topping the list was efforts to fill vacant posts, not only oncology specialists but other specialists and leading personnel needed to deliver effective health services in the province.
He also said a Health Technology Unit which was responsible for processing all KZN Department of Health purchases did not have the “required capacity leading to very long turnaround times for equipment purchases and maintenance”. He said that the unit had “not demonstrated the necessary capacity to run this function effectively (and) should not be allowed to purchase equipment on behalf of institutions”.
Motsoaledi proposed a deviation to allow the National Department of Health to procure equipment on behalf of the provincial authorities. “The practices of HR and procurement and supply chain management will have to be disrupted in more ways than one and this will need cooperation of the whole government, specifically the Premier’s office and the Treasury,” Motsoaledi concluded.
He said he had asked the KZN Premier to call an urgent meeting with the MEC for Finance, the MEC for Health, their senior support teams, the deputy vice-chancellor of the University of KZN, the dean of the Medical School and his five heads of department. This took place on 18 August and was followed by a week-long visit at the end of August by senior members of the National Department of Health.
The report says the SAHRC had conducted interviews with staff and patients in KZN, held in loco visits, and released a report on 15 June confirming that there were insufficient radiotherapy devices in the province. It reported both radiotherapy machines at Addington Hospital were not working. Patients had to wait for about five months to see an oncologist and an estimated eight months before they were able to start radiation treatment.
Addington was referring patients to the Inkosi Albert Luthuli Central Hospital, where equipment was working, and a plan to get private oncology specialists to provide pro bono treatment to attempt to stem the growing waiting list had been negotiated. The SAHRC had concluded in its report that the KZN Department of Health was failing to provide oncology patients with adequate health care services and that this amounted to a breach of their constitutional rights to health care and dignity.
The report says that the problems identified by the SAHRC were similar to those identified by the Department of Health, as were its solutions. At the committee meeting in Parliament, the minister was at pains to point out that some provinces did not have any sophisticated cancer detection and treatment equipment. Patients from Mpumalanga and Limpopo, for example, had to seek treatment in large centres in Gauteng. The North West shared its resources with the vast Northern Cape province.
The report says it was unclear whether the minister was using evidence of equal or worse healthcare provision in other provinces to justify the inadequate medical services in KZN that had made headlines. What was clear was that the Minister felt that as a concurrent responsibility, healthcare fell under provincial responsibility, at least when it came down to the two areas of dispute, namely human resources and procurement. Motsoaledi made it clear that this applied to healthcare across the board, and not only oncology services.
The report says the minister has shaken up the supply chain management procedures to remove much of the red tape that obstructed purchases of goods and services. However, an ongoing dispute with the service provider contracted to maintain the equipment is now bogged down in a court case, although there has been some progress, with one of the radiotherapy machines at Addington now being repaired while the other is to be procured by the national Department of Health.
Motsoaledi and KZN MEC for Health Dr Sibongiseni Dhlomo both made statements in Parliament saying the crisis was being addressed. They presented a plan of action on the repair and procurement of cancer machines and the employment of oncologists. But, says a Sunday Tribune report, on the ground, there was a different reality. Nurses and senior registrar doctors at Inkosi Albert Luthuli Central Hospital said patients were still dying waiting for treatment while the Department of Health still had not presented a plan to them.
The report says positions for oncologists have been advertised but had yet to be filled. And the registrar doctors said the plan to have private oncologists offer their services had also backfired as they were only available for two days a week, for two hours.
Dhlomo told the committee that his plan of action focused on the repair of the cancer machines, the management of patients and the recruitment of oncologists.
Meanwhile, a forensic report into the oncology crisis and the broken cancer machines, which was meant to be released on Friday, did not appear. But Department of Health spokesperson Joe Maila said the report in question had nothing to do with the oncology crisis and that there seemed to have been a misunderstanding.
“Nobody said anything about this report being released publicly. It is not even an oncology forensic report, it is a report into KZN Health. There appears to be some confusion,” said Maila.
The report says the KZN Treasury, which was apparently meant to release the report in question, also claimed to know nothing about its release.
But the much-awaited forensic investigation report into the breakdown and disrepair of two cancer radiotherapy machines at Durban’s Addington Hospital will probably not be made public because it contained “nothing new”.
News24 reports that this is according to KwaZulu-Natal Finance MEC Belinda Scott who said that “certain key people from national government” were getting a full brief on the forensic report, but it was “certainly not open” to the media. The report was expected to cover alleged procurement irregularities within KZN’s embattled health department and to supply information on maintenance contracts for two Varian RapidArc linear accelerators at Addington.
Scott at first said she would not release a statement on the report or the report itself, but then said “not yet”. When asked if the public did not deserve to know the outcome, she said: “I think you already do know. I mean it’s been all over the news about the oncology machines – there is nothing new”.
The report says in April 2016, it was revealed that the KZN health department had entered into a deal with KwaZulu-Natal Oncology Inc that had literally broken every rule governing the way government departments are meant to procure services. Motsoaledi told the national health portfolio committee that Scott would make a presentation on the report. Opposition parties, unions, civic organisations and other interested and affected parties have been awaiting the findings.
The DA provincial spokesperson on health, Dr Imran Keeka, said that Dhlomo had told members of the select committee on social services and select committee on education and recreation at a debriefing session at Albert Luthuli Hospital that the report would be released. “The DA anticipates that the probe, amongst other matters, will include findings regarding a company that has supplied radiotherapy equipment to the department and confirmation of payment irregularities. The Health MEC has mooted this for years,” said Keeka.
“In the event that this is the case, the DA will insist that the findings be forwarded to the Directorate for Priority Crime Investigation (the Hawks) who have been investigating the matter since 2010 without progress. It is hoped that any new information will strengthen their case and spur action on their side.”
Keeka said that if the report was not released, it would mean pronouncements made to this effect by Dhlomo and Motsoaledi were “misleading”.
General secretary of trade union Hospersa, Noel Desfontaines, said they were awaiting Treasury’s report with “bated breath”. “We signalled the alarm bells in 2009 when the department of health was caught up in a multi-million rand corruption scandal involving the maintenance contract of radiography machines at Addington Hospital. This corruption scandal had a domino effect that resulted in many lives lost due to limited access to cancer treatment,” he said.
Desfontaines said the union had “no doubt” that senior officials in the province were implicated in the 2009 corruption deal, which it believes led to the current crisis. “Government needs to send out a clear message that corruption will not be tolerated especially in instance where it has had a direct result to the loss of human lives,” said Desfontaines.
“We reiterate our call for the KZN Health MEC to be held accountable for allowing cancer treatment in the province to collapse and for the many lives that lost their fight against cancer due to the broken machines, shortage of staff and poor working conditions in KZN public health facilities.”