It has been almost four years since the North West Department of Health was put under administration in 2018, but some healthcare users in the province say improvement in health services has been negligible. They complain about medicine shortages and a lack of ambulances making it difficult to access healthcare services, especially in rural areas, writes Nthusang Lefafa for Spotlight.
The North West Health Department was placed under administration on 25 April 2018 after several governance failures and allegations of fraud and corruption resulting in service delivery protests.
It was among 10 departments in the province placed under administration under Section 100 of the Constitution. Section 100 allows national government to intervene in the running of these departments when they cannot fulfil their functions.
Dr Jeanette Hunter, deputy director of Primary Healthcare in the National Department of Health, was appointed as administrator for the North West Health Department.
The Section 100 intervention is expected to be lifted in the coming months.
In March, Cogta Minister Dr Nkosazana Dlamini-Zuma said an exit report was sent to the National Council of Provinces (NCOP) to sign off and the intervention would be lifted for the 10 provincial departments. Dlamini-Zuma heads up the inter-ministerial task team appointed to oversee Section 100 intervention.
On her appointment as administrator, Hunter told Spotlight: “The entire administration was on the brink of collapse; workers were demonstrating, threatening to set alight departmental offices.”
Her first task was to bring stability to a department in disarray.
“Staff were demanding performance management and development system (PMDS) incentives and the filling of vacant posts. They were angry because there were talks of millions being wasted through Gupta-linked companies like Mediosa. The province’s entire labour bargaining structure had collapsed,” she said. Since then there have been some improvements but some challenges remain.
1. Some vacancies filled
“The vacancy rate has been reduced from 19% to 11%: 5,000 posts have been filled. This began with a workplan based on a diagnostic assessment: out of 111 tasks set out, we have completed 102 of them, translating to a 92% success rate,” said Hunter.
On appointment, she found a staff organogram last updated in 2007. Due to budget constraints, she was told by Treasury she could improve staff numbers with only the funds available.
Meanwhile, while presenting his 2022/2023 Budget speech last month, Health MEC Madoda Sambatha had said 1,121 permanent posts were filled in the previous (2021/22) financial year and this would improve the department’s capacity.
However, a report last year by the community-led clinic monitoring group Ritshidze said severe understaffing makes patient load management in clinics difficult. Out of 14 regularly monitored clinics, all have staff shortages.
To tackle this, Sambatha said the department established a database of unemployed health professionals in 2020. This week, however, when Spotlight inquired about this database, there were only 57 names on it. Asked how many have been employed since 2020, Lekgethwane said: “It currently does not remove those who have since been employed. This (57) is the total number since the database went live.”
2. Emergency Medical Services
Emergency medical services was flagged as a concern last year. Parliament’s (National Council of Provinces’) ad hoc committee on the 100 intervention in North West, upon adopting the oversight report in May 2021, recommended the task team “ensure the Transport Minister and Department of Community Safety and Transport Management resolve issues around the inability to … respond to provincial health transport needs, including the procurement and maintenance of the EMS fleet …”
There has been some improvement. In 2018 there were only 50 functional ambulances. There were 147 by 2021.
According to national standards, 350 EMS vehicles are required for the province. In his 2022 budget speech, Sambatha said it would take up to seven years to reach this level. Currently, the province has 138 ambulances, he said.
Meanwhile, Sambatha said they was looking at a leasing model, meaning they will rope in private ambulances to help with patient loads and reach the national norm within two to three financial years.
Hunter said there was poor record-keeping because they use a manual system, which delays payments, tracking of financial transactions, and staff records. She said a new system should be budgeted for.
In its 2021 report, the NCOP’s ad hoc committee also noted that improving ICT infrastructure and automation of document management and information generation processes are some outstanding challenges.
4. Medicine availability
Medicine is an issue. In its annual report for the 2021/22 financial year, the healthcare support services programme “responsible for procurement, storage, and distribution of medicines, surgical supplies, and other support services achieved 74% against a target of 80% for medicine availability”.
In his budget speech this year, Sambatha referred to ending medicines stockouts as his “second mega health delivery intervention”. “The department has continued with efforts to improve medicines and medical supplies availability,” he said.
By March, he said the department “met its standard national average medicine availability target of 80.5%”. “Categories such as ARVs, (and) vaccines for child immunisations remained above 90% since the third quarter while TB medication availability was consistently above 80%.” Sambatha said the department also paid all suppliers that were on hold since 2021/22.
According to some healthcare users like Lerato Modise, medicines are not always available. “I wake up at 5am on the day I visit Ratlou Clinic. Sometimes I wait nearly six hours or spend the day there. Sometimes I come back with my baby not receiving her (immunisation) vaccine. I get told to come the following month,” she says.
The EFF’s member of the provincial legislature who serves on the health committee, Kelebogile Kerileng, said there are still chronic medication shortages, infrastructure and security challenges at facilities.
Lekgethwane, however, said there is a plan to improve delivery timelines for medication, involving direct deliveries to hospitals while the medical depot will deliver directly to clinics.
5. Money matters
Although the department had not grown its accruals over the past four years, it remains a concern. Accruals are funds supposed to be paid to suppliers in a specific financial year but are carried over to the next year due to a lack of funding. Currently, annual accruals still hover around R1.2bn. Though the North West Treasury has allocated R350m to help finance the accruals, the challenges of insufficient budget allocations remain, Sambatha said.
The department also underspent its budget by 1%.
Lekgethwane told Spotlight that of the about R14bn health budget for the province in the 2020/21 financial year, the department underspent by R144m. This was mainly on the health facilities revitalisation grant, meaning money that was meant for new facilities, upgrades, refurbishments, or maintenance was not spent in full. “A request for a rollover on committed funds was granted,” he says.
Dr Oshupeng Maseng, a political science and international relations lecturer at North West University, said this means the “government has failed its people”.
“Under Section 100 there are still funds in the North West that were returned to national treasury. When money is being returned, there is no clear indication of improvement. It simply means that government has failed in service delivery. If budget has been returned, it simply means services have not been rendered,” says Maseng.
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