Dire state of health services in Mpumalanga and Limpopo

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A shortage of key medical and administrative staff has put Mpumalanga’s 13 district hospitals in dire straits, according to a report from the provincial legislature’s health portfolio committee, while Limpopo is faced with challenges ranging from a shortage of doctors and medication to corruption and dilapidated buildings.

The portfolio committee report paints a bleak picture of about 13 hospitals in the Ehlanzeni District – some hospitals have vacancy rates ranging from 35% to 75%. This includes non-medical staff, who play a key role in the finance and human resources departments.

City Press reports that the findings in the report mirror the report released in last December by Health Minister Aaron Motsoaledi’s task team that investigated conditions in hospitals around the country. The task team noted problems including shortages of equipment and linen, dilapidated wards and a lack of security. The team’s two-year investigation focused on a sample of 25 hospitals in Mpumalanga, Limpopo, Eastern Cape, Free State, Northern Cape and KwaZulu-Natal. In KwaZulu-Natal the team visited Prince Mshiyeni Memorial Hospital in Umlazi, Mahatma Gandhi Hospital in Phoenix, Addington Hospital, along Durban’s South Beach and King Edward VIII Hospital in Umbilo and found them crumbling and lacking basic services such as access to water.

Committee member and Mpumalanga provincial Democratic Alliance (DA) leader James Masango says the situation is dire. “It’s just too bad. Lack of staff is the biggest challenge. There’s a hospital that has overspent by 569% at this time of the financial year.” But, the report says, Mpumalanga Health Department spokesperson Dumisani Malamule did not respond to questions emailed.

In May, the South African Medical Association (SAMA) and public interest law centre Section 27 warned that the KwaZulu-Natal health system was in trouble, after health workers marched in Durban to highlight the crisis. In a memorandum addressed to KwaZulu-Natal health MEC Sibongiseni Dhlomo, the protesters list 16 problems. These include a shortage of staff caused by “unfunded, frozen and abolished posts”, a lack of posts for medical school graduates doing their community service, an overtime policy that SAMA and unions had not agreed to, failures with equipment procurement, shortages of supplies, problems with medical records and poor management.

In Mpumalanga, of the 1.7m people living in the Ehlanzeni district, at least 89% cannot afford private medical care and rely on public hospitals. The district includes the provincial capital Mbombela, as well as Barberton, Mashishing (Lydenburg), Bushbuckridge, Malalane, Komatipoort, Sabie and Graskop.

The report says according to a 2013 study by consulting firm Econex, done for the Hospital Association of SA, ideally there should be a ratio of at least 152 doctors for every 100,000 people. Ehlanzeni has only eight doctors per 100,000 people. The average ratio in South Africa, including private sector doctors, is 60 per 100,000. Other Brics countries fare much better in this regard: India has 70 doctors per 100,000 people, Brazil has 189 and China 194.

A private sector doctor, who asked not to be named, says in the report that he has stopped doing work for public hospitals out of fear of being sued. “I used to spend two-thirds of my life supporting public hospitals, but the situation is too bad now. You leave a patient after an operation and there’s no one to look after him or her. Then next thing you are sued when things go wrong.”

A patient at Rob Ferreira Hospital in Mbombela, who spoke on condition of anonymity, says the queues are so long that she has had to wait six hours before being attended to. “There are few nurses and doctors. They prioritise the critically ill, those bleeding from stab wounds and going into labour. I arrived at 22:00 and saw a doctor five hours later because my condition needed to be treated, but some of the patients had been there since 12:00 in the afternoon.”

The task team says in its report that hospitals operate under financial constraints, which are exacerbated by the ongoing instability of management appointments, political office bearers and interference with line functions.

“There are a significant number of key managerial posts that have been vacant for a considerable period of time in the provincial departments of health [and] a tendency exists for management, both provincial and hospital, to defer accountability for the deficiencies to others,” the report states.

The authors express concerns that hospitals are unable to recruit and retain skilled staff – both in clinical and support areas – and that this has negatively affected the ability of hospitals to provide quality healthcare.

The budget allocations to hospitals are often inadequate. Current budget allocations only allow for 60% of the budget to be spent on personnel, whereas many hospitals require up to 75% to operate hospitals effectively.


Meanwhile, the Limpopo health system is currently faced with various challenges ranging from a shortage of doctors and medication to corruption and dilapidated buildings. “I want more money to save the lives of our people. We cannot be competing with other government entities for money. I believe that health should be a number one priority,” Health MEC Dr Phophi Ramathuba is quoted in a Health-e News report as saying.

Some of oldest health facilities facing major challenges include Pietersburg Hospital which continues to exist with only one operating theatre on weekends and public holidays due to a shortage of staff; Nkhensani Hospital in Giyani which is without a senior clinical manager and CEO and Elim Hospital which continues to struggle with dilapidated buildings and a shortage of running water. Tshilidzini Hospital in Vhembe, also with dilapidated buildings, is so overcrowded that patients sometimes have to be discharged early to make a place for others. At Malamulele Hospital water shortages continue to be a challenge, as patients are forced to bath themselves using only buckets.

“We have made an appeal to the government to allow us to stop building new health facilities and to first renovate the dilapidated ones which we have. We cannot build new hospitals while the ones we have are not being maintained,” the MEC said.

The report says the shortage of staff has resulted in patients at most of the clinics and hospitals being forced to wait several hours before they are seen by a nurse or doctor.

“The dysfunction in Limpopo is claiming lives and leading to widespread suffering and the dignity of our people is being trampled upon every day. There are too few doctors and nurses, which is not acceptable. The shortages lead to long waiting times, longer hospital stays, higher numbers of death and increased pressure on the few staff we have”, said Treatment Action Campaign (TAC) provincial manager, Moses Makhomisani.

The report says the districts hardest hit are Vhembe and Mopani where a shortage of HIV test kits continues to be a challenge as pregnant women are not being tested. This means many women have to go for months into their pregnancies without knowing their HIV status, risking the child lives.

City Press report Health-e News report

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