R1bn debt burden drives Mpumalanga Health to the brink

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Mpumalanga’s public health system is teetering on the brink of collapse, and with debts from previous financial years having accrued to about R1bn, the department can neither afford to buy today’s medicines nor fill vacant posts. And, says a City Press report, Premier Refilwe Mtshweni’s recent cabinet reshuffle could be linked to this crisis after Health MEC Gillion Mashego was removed. Mashego was redeployed to the Public Works Department last week.

However, the Democratic Alliance (DA) believes Mashego’s redeployment is not enough, and the department must be placed under administration to steer it back on track. “This is a brave move by the premier but changing an MEC doesn’t mean the financial crisis will go away. The new MEC will not be able to move because there is no money. The current budget is paying previous debts,” DA legislature member Jane Sithole is quoted in the report as saying.

The department’s spokesperson, Dumisani Malamule, said task teams were appointed to review internal control measures and compare patient benefits to assess value for money and efficiency. “In addition, during its bosberaad the department developed a plan to deal with a number of challenges, including escalating accruals. The department is optimistic that the accruals will be reduced in the current financial year,” Malamule said.

He said the department accruals stemmed from budget shortfalls to fund critical accounts such as personnel, medicines and essential equipment. He said another cause for accruals was the fact that the department was funded with less than 27% of the provincial equitable share funding, but since the 2015/16 financial year, the provincial treasury had reviewed and increased this allocation. Malamule said the funding model, based on HIV/Aids client statistics was reviewed, and additional funding was allocated by the national health department.

“Given the funding changes indicated above, the department has received an increase in its allocation of the budget. This will assist the department to reduce accruals without compromising the quality of health services. Due to funding gaps the department was unable to pay all invoices related to non-negotiable and key accounts,” he said.

The report says Mpumalanga is home to 4.4m people, and 3.9m of them, or 88%, depend on public healthcare.

A diagnostic report produced by the DA on the province’s state of health and based on annual reports and legislature responses indicates: accruals have increased by 6% year on year. Accruals in the 2016/17 budget amounted to R794m and increased to R842.3m in the 2017/18 financial year; the biggest contributors to accruals in the 2017/18 financial year were medicine (R364.6m), medical laboratories (R112.4m) and compensation of employees/transfers (R109.8m); the department has an accrual of R74m for new buildings; unauthorised expenditure increased to R200m while R6.7bn in irregular expenditure was awaiting condonation; and the department’s national health insurance site in Gert Sibande has failed because the department only spent R26.6m of the R42m in conditional grants it received from national government to improve infrastructure over the past six years.

The report says tthe results of these accruals is that the department will not be able to appoint new staff, which will lead to long queues of unattended patients and a rise in negligence lawsuits because of overworked staff. So far, the department is facing about R70m in litigation costs. The department has 2,524 vacant posts and there is a dire shortage of medical personnel.

The report says Mpumalanga legislature portfolio committee on health report indicates that the province’s largest district, Ehlanzeni, with a population of 1.7m, only has 221 doctors and 1,540 nurses in 13 hospitals. This translates to eight doctors per 100,000 people. Ideally, there should at least be 152 doctors per 100,000 people, which is the world average, according to an Econex 2013 study for the Hospital Association of SA. The average ratio, including private sector doctors, is 60 per 100,000, according to Econex.

Mpumalanga’s 3.9m people only have 10,178 healthcare professionals, 1,074 doctors, 79 medical specialists, 8,594 nurses, 300 pharmacists and 131 dental specialists and practitioners.

The accruals were, according also affecting the department’s targets. As a result, there has been a high default rate of patients on TB medication and depleted stocks for immunisations.

The report says Malamule admitted that the budget allocation for machinery and equipment was reduced in order to channel money towards paying the accruals. He said the department did not have money to fill all vacant posts for health professionals, but R108m was set aside to appoint 558 employees.

Malamule said the NHI grant had been stopped by the national department, but between 42% and 85% of the grant has been spent since the 2013/14 financial year.

City Press report

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