Financial problems are plaguing South Africa's health system, with the national Department of Health unable to hire sufficient nurses and doctors and the Gauteng Department of Health owing 808 service providers R1.2bn in late payments by the end of January.
The Department of Health revealed that it cannot afford to hire a full complement of nurses and doctors, telling MPs it was short of at least R3.2bn for the 2017-2018 financial year, reports The Times.
The department's director-general, Precious Matsoso, told the parliamentary standing committee on appropriations that the healthcare system had 45,733 vacant posts, and 351,925 filled posts – a 11.5% shortfall.
Limpopo has the highest number of vacant posts, 10,074, with 35,458 filled; and Eastern Cape has 7,005 vacant posts and 39,293 filled; Gauteng has 6,100 vacant posts and 68,000 filled.
The report says it is not known if the posts are vacant because of a lack of funds or a lack of skilled people. The posts include those for doctors, nurses, optometrists, audiologists, administrators, physiotherapists, financial and hospital managers, and maintenance workers.
DA MP Alan McLoughlin said: "It is known that as people resign from their jobs in hospitals and clinics, they are not replaced."
The SA Medical Association has been saying for at least a year that vacant posts were not being filled. Association spokesperson Mark Sonderup is quoted in the report as saying: "We have been raising this issue of frozen posts since 2016. You will recall it has been denied repeatedly by the minister. He even called me personally at one stage asking where I had obtained such false information. I guess it wasn't fake news after all."
The report says that at a press conference in February last year Health Minster Aaron Motsoaledi denied that vacant posts were not being filled. He said: "We want to put it on record that there are no medical posts frozen in this country … If there is freezing of posts by government departments, they have nothing to do with medical doctors as posts in the health sector are exempted."
But director-general Matsoso told parliament: the risk of medical negligence lawsuits increased with the shortage of staff; two state-of-the-art buildings in the Free State could not be opened because there were no health workers to staff them; and the department's budget was declining as increases were not keeping up with inflation.
Matsoso said health spending had risen faster than economic growth and providing healthcare would become unaffordable without systematic reform. "If the current trends continue, the health sector will have to reduce its services," she said.
A specialist working in a state hospital said having staff shortages was "exhausting, completely and utterly exhausting". "Patient numbers keep increasing but budget cuts limit what we can do for them."
According to the minutes of the meeting of the parliamentary committee, Matsoso said there were too few health technologists in some provinces to perform important work on health equipment. An official from the office of the auditor-general told MPs there were staff shortages in clinical engineering units in all provinces except Gauteng and the Western Cape, so maintenance of medical equipment was not undertaken.
South Africans suffer both from infectious diseases common in developing countries, such as TB, and non-communicable diseases typical of wealthy countries, such as diabetes, high blood pressure and heart attacks. These "colliding epidemics" was straining the health system, Matsoso was quoted in the report as saying.
One new doctor said: "My internship was done at a very understaffed hospital. It certainly affects morale. It makes you hate getting up in the morning and makes you feel hopeless – no matter how hard you work, it will never be enough. You can't do the work of three people."
The Gauteng Department of Health, meanwhile, owed more than R1.2bn in late payments to 808 service providers as of the end of January due to insufficient budget allocations and an increase of patients from other provinces, reports Business Day. The budget for the province’s public health system increased from R37.6bn in 2016-17 to R40.2bn in 2017-18.
Of this, R893.8m was allocated to support mental-health patients. This follows the death of more than 100 psychiatric patients who were moved from Life Esidimeni facilities to unlicensed nongovernmental organisations and the resignation of former health MEC Qedani Mahlangu.
Health MEC Gwen Ramokgopa said in a reply to DA questions that 38% of companies dealing with the department had been paid within the 30-day period at 31 January. The department cited the settlement of legal claims from monies that were meant for service delivery and payment, payment of arrears incurred as a result of increased patient numbers from other provinces and an increase in foreign national patients as the main reasons.
The report says that among the companies owed is Adcock Ingram Critical Care, which the department said was owed R2.4m. But this figure is different to Adcock Ingram’s records, which revealed that at the end of January an amount of R8m was outstanding for a period greater than 180 days.
Adcock’s corporate affairs manager Vicki St Quintin said that a small part of the variance, between the two records, may be attributable to the entities having different month-end cut-off dates.
"We are constantly in contact with the provincial health departments to ensure all the relevant documents are submitted in order for outstanding amounts to be settled." St Quintin said that "in addition to the amount listed for Adcock Ingram Critical Care, the Adcock Ingram Healthcare financial records indicate that an amount of R1m was also outstanding for the same period".
The report said that General Electric SA, which was owed just more than R7m, would not comment on the matter, saying that it would be "inappropriate for us to discuss any of our customers with third parties."
Prince Hamnca, head of communications at the provincial health office, is quoted in the report as saying that Ramokgopa met with suppliers two weeks ago to explain the difficulties the department faced and to assure them payments would be made.
The health department has pledged to manage key cost drivers and limit commitments for necessities while utilising available stock. The department also committed to intensifying revenue-collection and tackling all process challenges to the procure-to-pay system. "There will be payments made as we start the new financial year," said Hamnca.
[link url="http://www.timeslive.co.za/thetimes/2017/04/04/Health-department-in-sick-bay-R3.2bn-budget-shortfall-leaves-11.5-of-jobs-unfilled"]The Times report[/link]
[link url="https://www.businesslive.co.za/bd/national/health/2017-03-30-gauteng-health-department-owes-r12bn-to-firms/"]Business Day report[/link]