The Chris Hani Baragwanath Academic Hospital was this week thrust into the spotlight again, this time over a drastic shortage of food for patients and claims that neonatal deaths were as a result of 'avoidable incidents', MedicalBrief reports.
Gauteng Health has denied the food shortage, despite a source saying the hospital is borrowing food from other institutions and that patients are being fed baked bean soup, with staff desperately trying to make a plan about how to feed them.
The root of the problem appears to lie in maladministration at the provincial Health Department and the failure to pay suppliers on time, reports Daily Maverick, which was first alerted to the problem last week when a departmental head contacted the news site, saying: “Once again there is a food crisis at Bara – suppliers weren’t paid, also there is no soap and hand towels – and as a result infections are spreading.”
The health worker said this was a long-standing problem that “has now reached crisis point – companies are refusing to deliver because of non-payment”.
The issue appears to be linked to companies being awarded tenders to supply a number of different products “so, for example, if they are not paid for eggs they refuse to deliver milk”.
The hospital had also apparently been struggling with the supply of dry groceries since January. Part of the problem, said the staffer, was the award of tenders to small contractors who can’t meet the demand.
Explaining what it meant in terms of day-to-day care, the doctor said that “when there was no white meat, cheese was purchased”. However, “Now there’s no petty cash, so no cheese!”
She said the hospital had been “dealing with the crisis day-to-day from petty cash, which was depleted. Today patients are now having baked bean soup as a protein because the supplier has not been paid. It’s unacceptable that our patients are going through this.”
Another senior health worker confirmed the allegations.
“This is a province-wide problem involving non-payment of suppliers and the non-delivery of perishable groceries. Kitchens from different hospitals are borrowing food items from each other to feed patients.”
In this case, Bara is borrowing food from South Rand Hospital in Rosettenville and Bheki Mlangeni District Hospital, also in Soweto.
“It has been a problem for the past two weeks, mainly affecting protein. The same problems are being experienced with drugs and dry stores,” she said.
The doctor claimed the chief financial officer at the Gauteng Department of Health (GDoH) central office was not signing off on supplier payments: “I don’t think he understands the implications of his actions for patient care. It limits the scope of patients’ diets and quantities per meal.”
Due to the financial crisis in the department there are also “major acute infrastructure issues in critical areas not being attended to, leading to closure of beds and cancellations of elective surgery”.
The doctor said that “most hospitals are quiet because of intimidation. Only CHBAH has flagged these problems with the GDoH’s acting HOD and the MEC, Nomantu Nkomo-Ralehoko, but no solutions have been brought forward yet.”
She warned that there was a possibility of medical waste removal stopping “with effect from tomorrow” due to non-payment.
Another health worker described “the sewer stench in our outpatients section at CHBAH that patients and staff have to deal with daily” and that there are no she-bins in bathrooms for staff to discard their sanitary pads.
These reports should embarrass Gauteng Premier Panyaza Lesufi who, on assuming office in October 2022, gave a speech in which he said: “We are serious about health. Hospitals must not be the way they are now. We are starting with (fixing) the hospitals in the townships, as part of our broader township development agenda. We want to see a 360-degree change.”
Justifying the appointment of an MEC with skills in financial management (but not in health) he said: “This must be the department that pays service providers within 30 days. If you don’t pay, you don’t get services; if you don’t get services people don’t get quality.”
Motalatale Modiba, spokesperson for the Gauteng Department of Health, said: “There has not been a shortage of essential food in the past two weeks.
“There has been an intention by the supplier to withhold protein food items (such chicken and fish) due to payments beyond Chris Hani Baragwanath Academic Hospital that needed to be cleared. The challenge had to do with the end of financial year closure and delays in the reloading of budget commitments for processing.
“As things stand all meals have been provided to date, including special meals.”
Addressing the media this week during an oversight visit, Nkomo-Ralehoko confirmed there was a shortage of food but denied that any patient had gone a day without receiving meals. She blamed poor contract management and not enough cold storage capacity at the hospital as contributing to the shortages.
She said she was alerted to the shortage at the weekend, and was also well aware that around this time last year – towards the end of the financial year – similar challenges had been experienced, reports TimesLIVE.
Nkomo-Ralehoko said systemic issues exacerbating the situation, based on the report obtained from hospital managers, include:
• Contract management – poor contract management and escalation of challenges.
• Cold storage – the hospital does not have enough cold storage capacity to enable food to be procured in large quantities.
• Capacity of suppliers – some suppliers are over-contracted and cannot keep up with the demands of the orders. This relates to the appointment of multiple suppliers instead of contracting one supplier for multiple items, which they end up not being able to deliver.
She said the department would review the problem so that their services were not compromised by the appointment of service providers who do not have the required capacity.
“I need to reiterate …that while the situation at Bara is not ideal, there is no patient who went a day without receiving meals. As things stand, all meals have been provided to date, including special meals.”
Meanwhile, despite the department also protesting that not a single case of negligence was related to the 1 565 neonatal deaths in the maternity ward at Chris Baragwanath over the past three years, more than half of them were actually associated with avoidable incidents, according to DA Shadow Health MEC Jack Bloom in PoliticsWeb.
Nkomo-Ralehoko conceded, in response to questions in the legislature, that there were 909 possible avoidable factors linked to the deaths, including:
- 589 cases of inadequate infection control;
- 211 cases of limited neonatal ICU beds;
- 70 delays in case management/underestimating seriousness; and
- 39 cases of hypothermia.
A total of 1 443 babies were born with intrapartum hypoxia (lack of oxygen during delivery), and 997 with various stages of encephalopathy (brain injury), broken down as follows:
- 579 (58%) with mild encephalopathy;
- 300 (30%) with moderate encephalopathy; and
- 118 (12%) with severe encephalopathy.
The MEC said babies born with severe encephalopathy will have signs of brain damage in the long term, those with mild encephalopathy are unlikely to have signs of brain damage in the long term, while those with moderate encephalopathy will need follow up as it is difficult to predict who will have brain damage in the long-term.
“Gauteng Health seems to be in denial about the conditions at this maternity unit, which faces more than 50 medical negligence claims totalling about R1bn. Half of these claims are for cerebral palsy caused by brain damage, with claims ranging from R10m to R51m,” said Bloom.
There are currently 652 staff at the maternity and neonatal wards, with 34 vacancies.
“These need to be filled as soon as possible, and the number of neonatal ICUs increased as the shortage leads to avoidable incidents. More needs to be done to ensure avoidable factors that injure babies are minimised in these busy wards, which deliver about 18 000 babies a year.”
TimesLIVE article – MEC knew at the weekend about food supply problems at Bara hospital (Open access)
PoliticsWeb article – 909 avoidable incidents as 1565 babies die at Bara Hospital (Open access)
See more from MedicalBrief archives:
Doctors feed patients at Bara as supplies run out and medical waste piles up
New Health MEC’s plan to reclaim Gauteng public healthcare
‘Alarming’ shortages at Chris Hani Baragwanath Hospital – Health MEC
The long, slow collapse of South Africa’s top hospitals