SA healthcare: It’s not collapsed, merely distressed — Motsoaledi

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BaragwanathWhile Health Minister Dr Aaron Motsoaledi this week claimed that government health services were just ‘distressed’, a Office of Health Standards Compliance (OHSC) report listing shocking failings has been tabled in Parliament, with Health Ombudsman Professor Malegapuru Makgoba describing the system as ‘collapsing’.

Business Day writes that according to the OHSC report, only five of the 696 hospitals and clinics it inspected in 2016-17 complied with the Department of Health’s norms and standards to achieve an 80% ‘pass mark’.

The OHSC is a statutory body charged with assessing the quality of hospitals and clinics. It will shortly be taking on the responsibility of determining whether healthcare facilities meet the grade to be accredited for providing services under the National Health Insurance.

The report says the results of its latest inspection repor raise the prospect that few public healthcare facilities will make the grade. The inspections covered just under a fifth of SA’s 3,816 public health facilities.

The report says Motsoaledi issued a statement on Tuesday conceding that the public health system was overloaded, with long waiting times and diminishing quality at some health facilities. But he was at pains to emphasise that the healthcare system was still able to provide treatment to 4.2m people with HIV, the largest number in the world, care for 300,000 tuberculosis patients and had improved care for pregnant women with the MomConnect mobile app. Deaths from TB had halved between 2009 and 2015, falling from 69,251 to 33,603 over the period, he said.

“We do not think that a collapsing or collapsed system can be able to do these (things),” he said. “We are very worried about extreme overcrowding in our hospitals and we believe that it could have been much worse if we did not take proactive steps.

“One of these steps was to decant patients away from the clinics and hospitals to take their medication in selected pick-up points. We have 2.2m people on this system, (and) are poised to load 1m more people on this system during this financial year.”

Motsoaledi said he was aware of the lack of hospital management skills and the negative attitudes of staff in many facilities and would deploy 200 officials from the national Department of Health to assist public hospital managers.

The report says in stark contrast to the image painted by the minister, the OHSC report presented a picture of a public health system in shambles. The only compliant healthcare facilities among those it inspected were Gauteng’s Far East Rand Hospital, Danville and Laudium clinics, Potchefstroom Hospital in the North West and Paarl Hospital in the Western Cape. The worst facility was Limpopo’s Lephepane clinic, which scored just 20%.

CEO Siphiwe Mndaweni presented data showing there had been little or no improvement in the overall score awarded to seven provinces, while the scores awarded to the Free State and Gauteng slid between 2014-15 and 2016-17.

The report says the inspections were unannounced. The OHSC conducted repeat inspections in facilities that scored below 50%, and found many of the hospitals, clinics and community health centres had deteriorated over time, Mndaweni said. Patient safety and infection control scores showed little signs of improvement in the majority of facilities, she said. “There has not been a significant improvement in patient safety — this is a critical area that needs to be improved.

“We can never overemphasise the importance of infection prevention in health establishments,” Mndaweni said.

“Most provinces have not been doing well and showed a decline. This is also an area of concern,” she said.

 

Motsoaledi denied that the country’s health system is facing a total collapse‚ after comments in the media claimed this was imminent. The Times reports that he did admit‚ however‚ that it was seriously “distressed”‚ with shortages of medical and nursing staff in state hospitals and a huge number of sick patients with HIV‚ diabetes‚ TB or cancer.

He spoke of a huge “avalanche of patients” visiting Gauteng from Limpopo‚ Mpumalanga and the North West for cancer treatment.

The report says the minister was holding a media conference on Tuesday after being inundated with media queries about “the collapse” of healthcare. This followed comments by Health Ombudsman Malegapuru Makgoba and the Committee of Medical Deans about serious issues in the health system‚ with Makgoba warning of a health system collapse.

The report says when challenged by journalists about multiple critiques of a failing health system by the Treatment Action Campaign‚ the SAMA doctors’ union and medical deans‚ he said: “The issue of a crisis is not what I am talking about. I am talking about total collapse.”

He admitted many posts for doctors in Gauteng hospitals were not filled. He added that many medical posts had not been filled in the North West. “When we placed the North West under administration we found huge vacancies. This month we are going to fill 223 vacancies at the cost of R150m‚” he said.

Asked how he could implement National Health Insurance responsibly when the health system was not working‚ Motsoaledi said the NHI was needed because of these problems.

He was asked if‚ given the Esidimeni tragedy‚ long waiting lists for cancer treatment‚ staff shortages and violent strikes in hospitals‚ he considered himself fit for the job as health minister. But he failed to answer the question.

He said: “I leave that in your hands‚ I cannot stand here and make that judgement for myself. I find it very difficult to answer that question for myself.”

 

Motsoaledi expressed shock in finding around 70 babies in the neonatal ward at Gauteng’s Tembisa Hospital, which was built to house just 40 newborns, says a Bhekisisa report. “We are painfully aware of the lack of management skills in most of our hospitals.”

The health minister believes the 200 hospital deployees would minimise waiting times and improve facility management. The report says the officials will remain at healthcare facilities for a trial period until the end of June.

Most of South Africa’s healthcare woes can be linked to staff shortages amid growing patient numbers, Motsoaledi said. Meanwhile, the national health department will pursue private-public partners to help lessen patient loads at hospitals. The department will contract 250 private GPs to treat around 50,000 people living with HIV. The government will be contracting private cancer specialists to help address backlogs in cancer treatment.

The report says last year, the department launched a similar plan in KwaZulu-Natal. The University of the Witwatersrand-owned Wits Health Consortium was awarded a six-month contract to provide cancer treatment services in the province. The province has battled a dire shortage of cancer treatment specialists, forcing patients to wait up to 12 months to see a doctor, a South African Human Rights Commission hearing into the crisis found in May.

 

Regardless of what term you use, a Daily Maverick report says people are suffering due to poor care and the minister wants a pat on the back because his system works – sometimes.

The report says the roles of heroes and villains were clearly defined at the Life Esidimeni Arbitration, established to probe the death of 144 psychiatric patients in Gauteng. Health Ombudsman Professor Malegapuru Makgoba fell on the right side of history. His investigation launched the arbitration and just over six months into his job his work was crucial in the search for justice for families of patients who were sent to their lonely and brutal deaths.

Makgoba respects facts and is careful with his words. Testifying at the arbitration, he provided clear answers to questions from Dikgang Moseneke, arbitrator and former deputy chief justice. Leaders of the Gauteng health department couldn’t do the same.

On Sunday, the professor commented on the country’s health system. “I think the state of healthcare, to sum it up by many other people, it’s collapsing. It’s collapsing,” he is quoted as saying. “It’s in a mess and it requires very strong leadership, but that leadership requires a lot of consultation. There’s a lot of wisdom in the country and that should be used effectively by the national minister.”

On Tuesday, the minister defended the health system against Makgoba’s comments. The report says Motsoaledi responds to crises faster than many public ambulance services, but despite almost 10 years in charge the calls never seem to stop and the minister remains stuck between defending his government’s efforts and acknowledging reality.

 

The health ombud had warned the country’s healthcare system is on the verge of collapse. Speaking on “The Modise Network” on Sunday, eNCA quotes the ombud as saying that he is looking at several concerning cases, particularly in Gauteng. “I’ve received close to 2,000 complaints, about 800 of those are from Gauteng. It just tells you the level of activity around complaints in Gauteng, in health alone. Nevertheless, I think there are many Life Esidimenis that are taking place throughout our country.

“I am leaving next week to go to the Eastern Cape to look at a potential Life Esidimeni. Somewhere is Fort Beaufort – I am going to spend a whole week there. There are a few of them, as you know there is the oncology problem in KZN. There is also an oncology problem that is now being looked after by the Human Rights Commission,” Makgoba said.

The report says Makgoba, who had investigated the deaths of 144 psychiatric patients in the Life Esidimeni tragedy, said many healthcare professionals involved were scared to speak up because they feared those in power. The patients died after the Gauteng Health Department transferred them to ill-equipped NGOs.

“They (the healthcare professionals) all knew that; they testified even in front of (former Deputy Chief) Justice Dikgang Moseneke. They knew what was happening was wrong, but they felt like they had no power; they were fearful of their principals or their leaders and they were contributing to this so-called collective responsibility that makes no sense to anybody.

“I interviewed 25 people from the department. I didn’t meet anybody who wasn’t fearful, fearful of the MEC, the HOD, the director of mental health at the time. They were all fearful of them.”

 

The SA Medical Association (Sama) has warned, meanwhile, that the Gauteng Health Department is heading for a financial disaster similar to that of North West. The Citizen reports that the North West Health Department was put under national administration in April following a month-long strike and allegations of corruption and mismanagement.

The Gauteng Health Department has struggled for two years to pay performance bonuses to medical staff, which led to the shutdown of Charlotte Maxeke Johannesburg Academic Hospital last week. The strike was led by members of various unions, including the National Education, Health and Allied Workers’ Union (Nehawu) and the Democratic Nursing Organisation of SA (Denosa).

The report says Sama was responding to news that all the provincial departments would foot the bill for the damages awarded in March to families in the Life Esidimeni tragedy. “It is very worrying,” said Sama chair Dr Mzukisi Grootboom. “And we hope that the health department will not end up paying the bulk of this, because already we are being told that there are no funds to employ new doctors, and we have been seeing in the media all of the instances where doctors were struggling to find employment after their internships.

“It really is a disaster.

“Surely, (Gauteng) is headed in the same direction as the North West, Limpopo and Eastern Cape Health Departments.”

Grootboom also pointed out that, in January, Gauteng finance MEC Barbara Creecy denied that the decision to end government’s contract with Life Esidimeni was due to financial constraints, as claimed by former health MEC Qedani Mahlangu. During the arbitration into the 144 deaths of mental health patients after they were moved en masse from Life Esidimeni, Mahlangu claimed her department was under pressure to cut costs. The transfer alone cost the national department R6m.

The report says Gauteng DA shadow MEC for health Jack Bloom has expressed concern that service delivery may be jeopardised by government’s decision to have other departments pitch in to foot the arbitration bill. “The funds to pay the R160.64m arbitration award to 135 families of Life Esidimeni patients, who suffered and died, will come proportionately from all provincial government departments,” said Bloom, citing statements made by Gauteng director-general Phindile Baleni at an oversight meeting last Friday.

“The national health department has been asked to assist, but this doesn’t seem likely as they already paid R6m for the relocation of Esidimeni patients from unsuitable NGOs to proper treatment centres.”

The department was already facing a negligence claim bill of over R22bn.

Meanwhile, the Gauteng ANC has urged police to deal with acts of criminality “which place the lives of patients at risk”, in response to last week’s chaotic protests at Charlotte Maxeke.

The report says following the Gauteng ANC’s provincial executive committee meeting on Friday, secretary Hope Papo said they had noted “with shock and disapproval the unprecedented escalation of destructive and life-threatening industrial action among workers in the health sector, where patients have now become the target”.

“We call on the authorities to deal firmly with any acts of criminality that put the lives of patients at risk. At the same time, we call on the Gauteng department of health and the unions to find an urgent and amicable solution to the current dispute on bonuses in the best interests of patients.”

And, the report says, Motsoaledi put the responsibility to deal with the impasse squarely on the shoulders of the province. Asked whether he would concede that the strike could have been averted had the provincial department addressed the performance bonus grievance, Motsoaledi said: “The issue of unpaid performance bonuses is not a matter for the national (department) of health. If (the Gauteng Health Department) needed my assistance, they would have said so.

“Gauteng has a premier, an MEC for health and MEC for finance to address the matter.”
The minister paid a visit to the hospital on Thursday night, after which he is quoted in the report as saying: “I went there because I was angry. I felt that, regardless of how genuine your grievance may be, you have no reason to attack patients who have nothing to do with this.”

The Gauteng Health Department could not be reached for comment.

 

The South African Committee of Medical Deans (SACoMD) has called on the government to take drastic steps to address the ongoing health crisis in the country, reports The Times. The committee said that despite multiple interventions on the part of the minister of health and the National Department of Health‚ it was of the view that the health system in South Africa remained in crisis.

“The Cabinet’s recent decision to place the North West Health Department under administration of the national government in the wake of the health worker protests and the appointment of the Intervention Task Team in the Gauteng Health Department to advise on a turn-around strategy are indicative of a limping and indeed failing health system‚” the committee said. “The deans are calling on government to take drastic steps to address the systemic failures in the provincial health departments as a matter of priority‚” it added.

The committee stated that an optimal health system in South Africa was a prerequisite for a well-functioning academic health complex to train and graduate quality health professionals at undergraduate and postgraduate level (including at specialist and sub-specialist levels).

The recent health workers strike in the North West province had brought into sharp focus the challenges facing the health system in South Africa‚ it said. “The deans are deeply concerned that industrial action by organised labour actively prevented the access to health care for the most vulnerable members of society and patients have died. These events follow several significant events in the national health system including the Life Esidimeni tragedy‚ the ongoing oncology service crisis and the ever-increasing burden of diseases‚ which all demand some introspection amongst those managing health services. These do not support an environment for the eventual realisation of a health system based on the concept of Universal Health Coverage.”

The report says the deans also expressed grave concerns about the future of academic medicine because of the chronic underfunding of health professional education and training‚ saying the absence of a national integrated and comprehensive health system plan‚ poor human resource planning‚ and poor governance and management of the health system continued to destabilise academic health services.

“The constant failure to adequately fund internship and community service placements for graduating health professional represents a serious human resources challenge as well as ethical disquiet. The deans believe that the national government has a duty to ensure that all South African students and those with permanent residence status should be placed in fully funded posts as this is a legal requirement for practice in the country.”

The committee was also deeply concerned that the additional training sites required to complete the training of the medical students from the Mandela-Castro Medical Collaboration Programme were still not fully prepared with only 60 days left before the first group of 720 students arrived back in South Africa from Cuba.

The report says the committee called on the national minister of health‚ in consultation with the national minister of higher education and training and the National Treasury‚ to urgently: ensure that all the training sites have been assessed and are ready to host the medical students returning from Cuba by 30 June 2018 (Mandela-Castro Medical Collaboration Programme); engage with organised labour to ensure that industrial action does not limit access to healthcare for patients (North West Province strike); initiate a policy development process in conjunction with the universities that will result in the publication of the regulations governing academic health complexes as provided for in the National Health Act of 2003‚ Chapter 7‚ section 51(a) and (b). The deans believe that this process must resolve the issues related to policy‚ governance‚ organisation and management‚ and the financing of academic health complexes; establish the national tertiary health services committee and national governing body for human resources for health (incorporating training and development) by the end of July 2018. These National Health Insurance implementation structures will enable the health and higher education and training sector to jointly plan the short-‚ medium- and long-term future of health services and health professions education and training. The establishment of a joint workforce planning process will also ensure that funding can be made available for guaranteed allocation in internship and community service posts; and facilitate engagements with the Parliamentary portfolio committee on health to host open and public hearings during June and July 2018 on the crises in provincial health departments. The outcome of these hearings should be addressed by government and where necessary and appropriate‚ to use the constitutional provisions in Section 100 of the Constitution to address the systemic failures in service delivery in these departments.

 

North West Social Development MEC Hoffman Galeng has, meanwhile, been meeting with the provincial leadership of the National Education Health and Allied Workers Union (Nehawu) over the past two weeks to resolve the disruption of health services in the province. News24 reports that since Nehawu members embarked on strike action in February, the provincial health sector has been under strain.

Department of Social Development spokesperson Petrus Siko said negotiations were at an advanced stage and were progressing well. “The union and the department have compiled a report on the issues affecting the employees and it will be presented to the Minister of Social Development, Susan Shabangu, on Friday by both parties,” he said.

The report says some of the union’s grievances include issues of outsourcing, corruption and unpaid bonuses. They have also demanded a forensic investigation into various provincial departments. “The two parties have agreed to stop the hostility against each other. The employer appeals to the employees to remain calm and continue with their daily work as both parties have agreed to exercise maximum discipline to allow the processes to be concluded,” Siko said.

Galeng assured employees that they would not be victimised or intimidated once they returned to work. “We are hopeful that the normal services will soon be restored and provided to the communities across the province,” Galeng said.

It was previously reported that President Cyril Ramaphosa had decided to place the North West Health Department under the administration of the national government in the wake of protest action. He appointed a team – under the leadership of Nkosazana Dlamini-Zuma – to get to the bottom of the crisis that was exacerbated by protests calling for the removal of Premier Supra Mahumapelo.

Business Day report
The Times report
Bhekisisa report
Motsoaledi’s speech
Daily Maverick report
eNCA report
The Citizen report
The Times report
News24 report


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