Powerful unions have pledged to combine their strengths and bring North West Health to a grinding halt, reports The Citizen. The reason is perceived corruption in the department, and to a large degree the organisations have shut down medical services to communities with a go-slow at pharmaceutical depots.
The unions taking the North West government to task are the National Education, Health and Allied Workers’ Union, the Democratic Nursing Organisation of South Africa, the Health & Other Services Personnel Trade Union of South Africa and the Young Communist League of South Africa.
“Over a period of time we have marched and held meetings with the management and political leaders of these two departments wherein we raised alarms around the gigantic appetite displayed by these departments for corruption, in particular the Department of Health,” The Citizen quotes Patrick Makhafane, Motlalepule Ramafoko, Lindiwe Matsipe and Tsietsi Letsebe as saying.
And, the report continues, while talks between unions and government have been happening, not much has been happening elsewhere.
“The last meeting was last week Friday; there was no agreement or a settlement so both parties after a proposal by the department agreed on external mediation,” said North West health spokesperson Tebogo Lekgethwane. “It was supposed to resume yesterday; however, we understand there is a team of three MEC’s appointed by the premier to try to come up with a political solution to the strike and to engage Nehawu,” Lekgethwane said. It did not mean the external mediation was necessarily cancelled, he noted.
Lekgethwane said in the report that the department was trying to make deliveries, but strikers were intercepting the trucks. Using police to protect deliveries was one of the plans, Lekgethwane said, adding there were “a number of plans” around what could be done to protect deliveries and in some cases the nurses, who were being threatened.
However, while politicians and labour unions flapped their gums at each other, strategised, planned and missed meetings, set meetings a week apart and pointed fingers, communities remained at risk. The report says there is a list of zero stock medicines at one provincial depot that supplies up to eight other facilities/clinics. It shows a total of 258 critical medicines and medical supplies critical to the health of patients and medical staff.
Simple things like gloves, suture kits, syringes and needles, sterile water, nebuliser masks, sterilisation bags, umbilical cord clamps, and sterilising solution are all out of stock. Critical basic medicines such as various penicillins; HIV tests and antiretrovirals; human papillomavirus, polio, rotavirus and tetanus vaccines; insulin; basic painkillers; and Ringers Lactate drip bags – also all zero stock.
The report quotes the Stop Stock Outs (SSP) project as saying that the national Health Department should work with provincial authorities to get medical supplies to clinics and hospitals, while unions and strikers have to allow access to the medicines within the depot for their distribution.
“SSP can confirm that antiretrovirals used to treat HIV in adults and children are not available,” said SSP project manager Glenda Muzenda. “Immunisation of children below nine months of age has been cancelled in some clinics, due to insufficient supply. Patient reports of stock outs have led to SSP being able to confirm that at least five clinics have closed their gates.”
The union representatives are quoted in the report as saying that North West Health was already in trouble before the current “labour impasse”. “It was already confronted by challenges of lack of medication in health institutions, lack of linen and bedding in health institutions, lack of and sometimes no proper meals for admitted patients in public health institutions, lack of medical equipment, overstretched and overworked staff as a result of staff shortages, and premature deaths of patients, young and old alike, due to the incompetency of the Buthelezi Emergency Services,” they stated.
Workers affiliated with Nehawu at the province’s medical depot are refusing to work until the provincial government meets a set of demands, including salary increases, committing to insourcing general workers and the axing of head of health Andrew Thabo Lekalakala. Bhekisisa reports that the call for Lekalakala’s dismissal comes after he signed off on a multimillion contract with Gupta-linked company Mediosa for a mobile clinic. Lekalakala has since been placed on special leave.
Nehawu’s provincial secretary Patrick Makhafane says he expects the protest action to continue on the heels of a new round of failed negotiations last week. Premier Supra Mahumapelo has now convened a crisis MEC task team that includes the MECs of health, social development and education to negotiate with the union. However, the latest meeting between the unit and Nehawu on Thursday was cancelled.
The report says Aids lobby group the Treatment Action Campaign, as well as public interest law organisation Section27, have also sent staff to the province to investigate.
Meanwhile, the province has sought the help of the National Health Department, which has asked pharmaceutical suppliers to begin bypassing the depot and begin delivering directly to clinics, according to health minister spokesperson Popo Maja. He adds that Gauteng and Northern Cape health districts are being roped-in to supply medication to the North West.
The report says Aspen Pharmaceutical began ferrying shipments to clinics last week after workers refused to accept ARV shipments delivered to the provincial depot, group senior executive Stavros Nicolaou says. Aspen is one of the four companies that provide ARVs to the public sector nationally.
“Suppliers, such as ourselves, have set up a direct delivery system….so that patients are able to start receiving their medication again, especially the chronic medicine,” he explains. Nicolaou says he hopes that clinics and hospitals will be re-stocked by the end of next week.
The department is considering using the military to help distribute medicine in the province, reports Business Day. Health Minister Aaron Motsoaledi was interacting with stakeholders to try to resolve the situation and officials were weighing up several practical options for getting medicines to patients, said the minister’s spokesperson, Popo Maja.
“The issue needs to be addressed at a political level. There are pressure points in other provinces, but North West is top of the agenda. There is a recognition that urgent intervention is required to ensure lives are not at risk,” said Maja.
Practical options for providing medicines to patients in the interim included using the military to distribute supplies and providing collection points, or setting up private sector collection points, he is quoted in the report as saying.
Patients were being sent away from healthcare facilities empty-handed or with smaller quantities of medicines than usual, said Amir Shroufi, medical coordinator for Medicines Sans Frontières SA (MSF). “Stock-outs are disastrous for patients. It is bad … for them emotionally and has quite serious economic consequences. Getting to clinics is expensive, and some just can’t afford it.”
Patients with HIV who had to interrupt their treatment risked developing resistance to the virus, which had long-term health implications, he said.
The North West Health Department appears to have broken the law when it used millions from the province’s Comprehensive HIV and Aids Conditional Grant to pay two private ambulance companies, Buthelezi EMS and High Care EMS, for “inter-facility transport”.
Marcus Low, editor of Spotlight writes in the Daily Maverick that a letter sent by KA Dibodu in May 2016 from the head of the North West Health Department’s office to district chief directors states that R36m from the province’s Comprehensive HIV and Aids Conditional Grant, were to be channelled to two private ambulance companies, Buthelezi EMS and High Care EMS.
Low writes that while the R36m referred to in the letter relates to the 2016/2017 financial year, the National Health Department said that R93m in HIV conditional grant funds was transferred to the North West in the 2017/2018 financial year for the line item in question “inter-facility transport”. This brings the total for the two years to a staggering R129m.
He writes that by law the HIV conditional grant can only be spent on HIV-related expenses. And various experts have confirmed that inter-facility transfers fell outside the scope of the HIV conditional grant and the spending would thus be unlawful. “The Division of Revenue Act and grant framework does not allow that a conditional grant should be used for a purpose that is not intended,” says Maja.
Low writes that according to Maja, the department has requested that National Treasury investigate the matter. Maja also indicated that steps had been taken by the National Health Department to ensure that North West cannot use HIV conditional grant funds for inter-facility transfers in the current (2018/2019) financial year.
Almost half-a-million people (around 482 000) in the North West are living with HIV (12.5% of the province’s population). The HIV conditional grant is meant to help the roughly 244,000 people in the province already on HIV treatment to stay healthy and on treatment and to get the 238,000 people who still need treatment on to treatment.
Low writes that a number of invoices submitted to the North West Health Department were from Buthelezi EMS CC. But, the Companies and Intellectual Property Commission (CIPC) registration number on these invoices (2013/06/5417/07) is not that of Buthelezi EMS CC, but that of another company called Buthelezi EMS (PTY) LTD. There is a Buthelezi EMS CC registered on the CIPC database, but its registration number is completely different from that on the invoices.
He writes that seen one invoice was seen where the branding on the invoice is not Buthelezi EMS, but B EMS. There is a company called B EMS CC listed on the CIPC database, but its registration number also does not match that on any of the invoices seen. The bank account number on the B EMS invoice also differs by one digit from that on other invoices. Some ambulances in North West have been rebranded as B EMS.
Low says the three Buthelezi companies mentioned above are only three of seven found with names that are in some way variations of Buthelezi EMS. All the companies have Thapelo Samuel Buthelezi listed as director. He says Buthelezi failed to answer a question on why he has registered so many companies with similar names adding that one clue might be that Buthelezi EMS (PTY) LTD, the company’s whose registration number appears on the service level agreement with the North West Health Department and the invoices, appears to have had some trouble filing its annual tax returns.
According to CIPC records a process of deregistration was started in April 2017 because the company had not filed tax returns since April 2014. With only a few extraordinary exceptions, companies cannot lawfully be awarded tenders or be paid by government without tax clearance certificates.
The service level agreement in question was signed in March 2016 when, according to CIPC records, the company could not have had a valid tax clearance certificate.
Low writes that CIPC records show that a week after deregistration was set in motion in April 2017 the company was suddenly taken out of deregistration and reinstated – we do not know whether this was because valid tax returns were finally filed or because of another reason – either way, it would not impact the lawfulness of the initial award of the tender.
CIPC records also reveal an interesting link between Buthelezi EMS and High Care EMS (PTY) LTD – the two companies who between them were awarded the entire North West inter-facility transfer tender with High Care getting Ganyesa District and Buthelezi the rest of the province.
Buthelezi, director of the various Buthelezi EMS companies, and Mogale Clifford Mahlo, director of High Care EMS, are listed as co-directors of companies called Vosloorus Ambulance Services CC and VAS Emergency Medical Services (both companies that have been deregistered because of annual return non-compliance).
Low writes that in February 2018 it was reported that North West Premier Supra Mahumapelo had authorised a forensic investigation into procurement at the provincial Health Department. In addition to the Gupta-linked Mediosa, Mahumapelo’s spokesperson stated that Buthelezi EMS will also form part of the investigation. Also reported on was the alleged overcharging by Buthelezi EMS, something which Buthelezi denies. Low says additional questions sent to Buthelezi were not answered.
Meanwhile, he writes, Buthelezi EMS continues to be paid by the North West Health Department. Invoices seen show figures in excess of R20m a month. In addition to the forensic investigation initiated by Mahumapelo, Buthelezi EMS is also being investigated by the Hawks.
Spokesperson for the Hawks in the North West Captain Tlangelani Rikhotso confirmed that they were investigating the contract between Buthelezi EMS and the North West health department, but said, “we cannot divulge any more information in relation to the case”.
Low writes that the North West Health Department declined to answer any of a long list of questions sent to them stating only that: “The management of the department has looked into all the questions posed. The department has also considered the fact that Buthelezi EMS and a number of other contracts are a subject of investigation by the Hawks as well as a forensic (sic) initiated by the Premier’s Office. In the light of these developments, the department feels that the investigations should carry on and a response will then be issued afterwards.”
He writes that the department was allowed additional time to reconsider this position but did not receive comment by the extended deadline.