Motsoaledi bemoans lack of control over provincial health departments

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South Africa’s Health Minister Aaron Motsoaledi says he has “zero authority” to improve the functioning of troubled state hospitals, which are all managed by provincial governments, reports News24. Motsoaledi has told the portfolio committee on health that a two-year ministerial task team report highlighted 19 key problems at hospitals in six provinces around the country.

The task team spent two years visiting the 25 hospitals, most of which were struggling with staffing issues, budget problems, high-level vacancies and poor service conditions. The minister said all 19 findings fell broadly into four categories, none of which were in his control. “My conclusion is that a minister in health has a huge responsibility, but zero authority where it matters the most,” the report says he lamented. “Such authority is with the MECs of both finance and health, their premiers and executive councils.”

The areas in which these hospitals are falling short include human resources, procurement, financial management and infrastructure, which are the responsibilities of provincial governments, he said.

“The two major healthcare crises that occurred in the last year – Life Esidimeni in Gauteng and oncology services in KwaZulu-Natal – are clearly procurement and HR problems,” Motsoaledi is quoted in the report as saying. Heads of departments are hired by premiers, but when they make errors “they come to me”, Motsoaledi said, adding that he had no control over appointments.

The report recommended that power be “decentralised” from provincial oversight. Hospitals should be allowed to manage and appoint their own staff, instead of having to wait for provincial appointments. “In a staffing matter in the Eastern Cape, the director-general once intervened and the provincial department obliged,” Motsoaledi said. This led to accusations that the intervention was a ‘political decision’, he said. Some hospitals needed the MEC’s signature to even “hire a cleaner”, in an environment where there was a severe “need to hold power”, he said.

Another problem was that hospitals were using, on average, 75% of their budgets on paying personnel, leaving, at best, 25% to run the hospital.

Budgets need to be increased, or hospitals must be allowed to manage their own staffing processes, so that the figure gets closer to a 60-40% split.

The report listed 25 recommendations which will be sent to the various provinces, and will also be tabled in Parliament and be discussed at Cabinet level. Legislation should also be considered to clearly define the separation of powers at state-run hospitals. This would affect at least 12 acts in the department’s “white paper”.

MPs are quoted in the report as saying that the buck ultimately stopped with the minister, and it was problematic if he did not “have the authority” to intervene in the running of government hospitals, as he claimed. Motsoaledi agreed, saying he and his department couldn’t keep returning to Parliament to “cry” about the same thing.

News24 report

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