The SA Human Rights Commission (SAHRC) has announced that it would not issue an “adverse” report on Gauteng Health after a probe into baby deaths, long waits for life-saving cancer treatment, overcrowding and critical staff shortages at hospitals.
The Times reports that the commission visited various hospitals in Gauteng during 2018 as part of its investigation into the department, including Charlotte Maxeke Academic Hospital and Steve Biko Academic Hospital following reports of cancer patients facing long waits for radiation treatment, and Rahima Moosa Mother and Child Hospital and Thelle Moegerane Hospital after learning that babies had died of infections there.
A report would be a “waste of time”, said commissioner Buang Jones. Instead, the commission would have meetings with the provincial health department and require it to submit progress reports on addressing its challenges. The commission hopes to sign an agreement with the department after the elections and to work together to find solutions to its problems.
Provincial health department head Professor Mkhululi Lukhele was asked questions about what the commission discovered during its inspections. The report says problems highlighted included: no room or space to keep patient files at Thelle Moegerane Hospital, meaning that documents and essential medical records could get lost; a shortage of radiation oncologists at Charlotte Maxeke Hospital, meaning cancer patients faced treatment delays; medical waste companies removing radioactive waste were on monthly contracts, in breach of tender rules; severe and systemic staff shortages, often with one nurse in a ward where 10 should be; ageing hospital buildings and infrastructure; failed departmental financial audits; patients were unaware that hospitals were supposed to have a system to hear their complaints; and a lack of clarity on National Health Insurance (NHI), despite it being frequently punted as answer to systemic health problems.
The report says Lukhele admitted to the commission that there were problems with ageing infrastructure as hospitals had not been maintained. He said the department had to put out a new tender for medical waste companies to remove radioactive waste and expired medicines. He said an existing month-to-month contract was in breach of the Public Finance Management Act. He also said the “age of fourth industrial revolution” meant that more medical documents and policies should be online.
According to the report, Lukhele spoke of severe staff shortages, saying the health system was “jammed”. He also said the department had an insufficient budget based on local population figures, when people from around the country sought medical attention in the province.
Jones thanked Lukhele for his honesty. “The fact that you admit there are challenges and have taken steps to address some of these challenges means we will not issue an adverse finding report. This would be a waste of time,” he said. “Instead, the commission would commence with a process of engagement with the department that would culminate in the signing of an agreement.”
The report says Jones was at pains to point out that this collaborative approach had worked before. “We have embarked on a similar arrangement with other institutions to ensure they have a protection of human rights … as a focus area,” he said. He added that the SAHRC still had teeth: “We remain independent and autonomous. The commission will continue to monitor your (health department) work. We will continue to work with communities … to find solutions. We will still continue to assert our powers where there are challenges and failures.
“We are hopeful an agreement will put forward lasting situations.”
Lukhele was asked about the commission’s investigations that exposed the severe shortage of nurses and doctors. The Times reports that Lukhele responded: “You have hit the nail on the head.” He said the number of people living in Gauteng had increased without a corresponding increase in health staff. “Ten years ago it had 7m people, now it has 14.5m. The system is jamming.”
He said that staffing and budgets had not kept up with demand for health services in the province. Nor did the health budget allocation from treasury keep up with public servants’ wage increases each year. The result was that “as a CEO you need 10 people but you have money for nine”. The report says President Cyril Ramaphosa announced in December that there would be more money to hire critical medical staff. Lukhele said the stimulus had helped “but it is still a drop in the ocean”. “The health system is going uphill, but the good thing is that it is still going.”
Senior legal officer Jackson Mzila told him that the commission had discovered that nursing shortages were systemic. Many wards that were supposed to have 10 nurses had only one, the report quotes Mzila as saying. A Gauteng Health Department letter was sent to all hospital CEOs in 2018, telling them not to hire staff to replace those who resigned or retired.
Legal officer Zamakhize Mkhize asked Lukhele about this “moratorium on staff”. But, the report says, he denied there was moratorium on staff, describing it instead as “CEOs having to manage the purse”. He said it was a “misinterpretation” of the word moratorium but explained that not hiring people was simply working within budgetary limits. “It’s not a moratorium … It is just managing the situation as it is with what you have.”
He understood doctors and nurses were frustrated when they did not have enough colleagues. “We cannot underplay the suffering it brings to CEOs and health workers.”
He also said nurses could become irritable after working long hours “due to the environment and pressure”.
The report says he touched on the fact that shortages of money, ventilators and other equipment could lead to doctors making hard decisions that did not benefit individual patients. “Sometimes you have to make difficult calls. You are looking at doing good for the majority instead of good for the one,” he said.