Two years after the Public Protector (PP) found that the Gauteng Health Department had failed to ensure appropriate conditions for the delivery of healthcare services, the situation at some of these hospitals has deteriorated further.
After visiting several hospitals in Gauteng in 2020, the PP made several recommendations which the provincial health department said it has implemented, Spotlight reports.
The inspections were to determine hospitals’ state of readiness to cope with the pandemic.
The PP team also examined additional issues, including the availability of services, human resource challenges, physical infrastructure and vital equipment, machinery, quality, the provision of personal protective equipment (PPE), and staff morale.
Between 18 and 20 August 2020, they inspected Jubilee District Hospital, Dr George Mukhari Academic Hospital, Steve Biko Academic Hospital, Chris Hani Baragwanath Academic Hospital, Lilian Ngoyi Community Health Centre (CHC), and Charlotte Maxeke Johannesburg Academic Hospital.
The findings and the ‘must-do’s’
When Spotlight asked PP spokesperson Oupa Segalwe about the Gauteng Health Department’s progress in implementing the recommendations, he said no response had been received other than acknowledgements of receipt from the responsible authorities. “Our compliance unit is following up with those who must implement remedial action.”
Spotlight put some of the PP’s recommendations to the department and asked for details on their implementation.
1. Supply chain issues
One recommendation was for the department to fix supply chain issues. Then acting head of the department Dr Sibongile Zungu had 30 days after the PP report was published to ensure the supply chain management unit was reassessed to determine if it had the capacity to respond to hospitals’ procurement needs.
Zungu had to determine and resolve the cause of the delays regarding procuring, maintaining, and delivering medical equipment to hospitals.
It is unclear if that was done since the department only responded to some questions.
2. Infrastructure and maintenance
Other issues flagged were occupational health and safety hazards, especially regarding infrastructure and maintenance.
Gauteng health spokesperson Kwara Kekana told Spotlight a risk committee does monthly assessments of structural challenges, which include assessing security, CCTV cameras, safety and security of patients and staff, and availability of security guards.
It also includes occupational health and safety issues like medical waste removal, availability of PPE and protective clothing, and other factors.
Singling out Jubilee District Hospital and the OHS projects, Kekana said the infrastructure priority list had been submitted by Jubilee’s management to the Gauteng Department of Health and the Department of Infrastructure Development (DID) in April 2021. Engineers did not do a conditional assessment in the previous financial year (2021/2022), but Jubilee has an occupational health and safety project that started in July 2021. This project, she says, has a detailed plan led by DID and the Gauteng health department.
The PP report also asked the department to devise a plan to resolve human resources issues at some facilities.
Regarding Lillian Ngoyi Community Health Centre, the PP recommended Zungu take steps to ensure that within 30 working days there were enough doctors to provide medical care, and a roster to monitor adherence to prescribed waiting times. The report did not specify a number but Kekana said there were currently nine doctors at Lillian Ngoyi CHC.
The Health Centre had no facility manager at the time of the investigation and the PP asked the hospital to appoint one. Kekana said Jacqueline Ngidi was appointed on 1 December 2021, with 27 years’ of nursing service.
Last week, Transport & Road Infrastructure MEC Jacob Mamobolo said the province would invest about R3bn in refurbishing hospitals this year.
“Our health and safety programme has received a lot of money,” he said, “and we will target 15 priority hospitals.”
Health experts respond
However, health experts say the problems are beyond just a few recommendations.
Dr Aslam Dasoo of the Progressive Health Forum (PHF), had his own diagnosis of the challenges. He told Spotlight that with nine provinces, health policies are all set up nationally but are interpreted in nine different ways. “As political hegemony develops within provinces, they have the right to distribute the funds (budgetary allocations) and put whoever they want as heads of departments,” he said.
“As that develops, so does the dissipation of policy. Suddenly, every province is running its things its own way. And you don’t have proper management accountable to the civil service. They are usually appointed for political reasons – mainly to facilitate the corruption of healthcare funds.”
Pitfalls of poor leadership
With the poor management and poor allocation of funding for health services these services deteriorate, he added.
“The Gauteng provincial government is riddled with criminal syndicates … take Charlotte Maxeke as an example, it’s a year since that fire. The most well-resourced province in the country can’t fix one hospital in a year.”
He said the deterioration in the public system has been accompanied by an escalation in private care. “When staff leave for the private sector, the government doesn’t fill these vacancies because the money has run out. It’s used on other things which are not always legitimate.”
‘Medieval horror show’
Dasoo says the public health system loses not only patients but also staff, and once they leave the public health system for the private sector, it’s impossible to get them back.
“You can’t get those doctors back because who would want to go into Helen Joseph Hospital, which was seeing the overflow from Charlotte Maxeke (after the fire) – and all of Charlotte Maxeke’s psychiatry patients, 30 to 40 at a time. Last year, Helen Joseph Hospital didn’t have water. Gift of the Givers had to drill a borehole – the mighty Gauteng government couldn’t even drill a borehole.
“When you walk into Helen Joseph, it’s like walking into a medieval horror show in the most industrialised city on the continent.”
Throwing money at the problem
Russell Rensburg, director of the Rural Health Advocacy Project (RHAP), said throwing money at the problems is not enough.
The challenges could only be solved with a proper evaluation of what the health system does with the money (allocated to them) and looking at where there are inefficiencies, he said.
Gauteng receives enormous budgets compared with other provinces. “The money must be directed to where the people are: prioritise those who have the least access or the least ability to pay for primary healthcare or public sector health facilities.”
The government should evaluate what the health system delivers and what people need, he added.
“They must look at the efficiency of our hospitals. Are they delivering what they are funded for? They must do an assessment of how the system delivers, how it can deliver better with available funding, and how to make the primary health care system more accessible to a large percentage of the population.”
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